Methods for integrating scans including 3d cone beam scan for positioning of implant and fabrication of dental prosthesis

ABSTRACT

Methods for taking a scan of a patient&#39;s oral cavity for use in fabricating a dental prosthesis. Such methods may include providing a healing cap configured to be received within a subgingival void of a given tooth position, taking a first scan of the healing cap, wherein the first scan is taken outside of a patient&#39;s oral cavity, seating the healing cap, taking a second scan, which is an intraoral scan of the healing cap and surrounding surfaces once the healing cap is seated, taken inside the patient&#39;s oral cavity; and integrating the first scan of the healing cap with the intraoral second scan of the healing cap and the surrounding surfaces into an overall oral cavity scan. A third scan, (e.g., 3D cone beam scan), can also be taken, which is overlaid or otherwise integrated with the first and second scans, for use in fabrication of a dental prosthesis.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation-in-part of U.S. patentapplication Ser. No. 17/349,668 filed Jun. 16, 2021, which is acontinuation-in-part of U.S. patent application Ser. No. 16/851,826filed Apr. 17, 2020, which is a continuation-in-part of U.S. patentapplication Ser. No. 16/551,382 filed Aug. 26, 2019 (now U.S. Pat. No.10,709,525), which is a continuation-in-part of U.S. patent applicationSer. No. 15/270,804 filed on Sep. 20, 2016 (now U.S. Pat. No.10,507,081), which is a continuation-in-part of U.S. patent applicationSer. No. 14/327,869 filed Jul. 10, 2014 (now U.S. Pat. No. 9,895,209),which is a continuation-in-part of U.S. patent application Ser. No.14/152,369, filed Jan. 10, 2014 (now U.S. Pat. No. 9,572,640), which isa continuation-in-part of U.S. patent application Ser. No. 13/633,387filed Oct. 2, 2012, (now U.S. Pat. No. 8,628,327). U.S. patentapplication Ser. No. 14/327,869 is also a continuation in part ofInternational Application No. PCT/US2013/020992, filed Jan. 10, 2013,which claims priority to U.S. patent application Ser. No. 13/347,127,filed Jan. 10, 2012. The disclosure of each of the above patents andapplications is herein incorporated by reference in its entirety. U.S.patent application Ser. No. 15/270,804 filed on Sep. 20, 2016 (now U.S.Pat. No. 10,507,081) is also a continuation in part of U.S. patentapplication Ser. No. 14/485,351, filed Sep. 12, 2014 (now U.S. Pat. No.10,016,260) the disclosure of which is also incorporated by reference inits entirety. All publications, patents and patent applications citedherein, whether supra or infra, are hereby incorporated by reference intheir entirety to the same extent as if each individual publication,patent or patent application was specifically and individually indicatedto be incorporated by reference.

BACKGROUND OF THE INVENTION 1. The Field of the Invention

This invention relates to casting jigs and associated methods formanufacturing healing caps or cuffs used in any stage of oral surgerywhere a tooth is extracted or missing. Such an example of oral surgeryincludes first stage oral surgery, for example, when an implant isinitially placed into a tooth void (e.g., whether the tooth is extractedor was congenitally or otherwise missing). The inventive healing caps orcuffs may also be used in any other dental surgery where it is desiredto preserve the emergence profile of gingival tissue surrounding one ormore teeth (e.g., second stage surgery, immediate or delayed implantplacement, etc.).

2. Background and Relevant Art

In modern dentistry, when one or more teeth are removed it is desirableto eventually replace the tooth or teeth with a prosthesis (e.g., acrown, bridge, etc.), although this is typically accomplished weekslater. Once the tooth is removed or missing, a dental implant is placedinto the bone tissue of the jaw to provide a secure foundation uponwhich a prosthesis can be supported. Typically, the site is allowed toheal for a period of time prior to installation of the permanentprosthesis. Currently, a device known as a healing cap, abutment, orcuff is coupled into the dental implant while the site is allowed toheal, to cap or cover the inside of the dental implant and to preservethe ability to re-access the dental implant once the site hassufficiently healed, when it is desired to install a prosthesis. Oncethe site has healed (e.g., typically 1.5 to 6 months after implantplacement), the healing cap, abutment, or cuff is removed, and a customprosthesis (e.g., a crown) may be installed, supported by the dentalimplant anchored within the jaw bone.

Existing dental healing caps, abutments, or cuffs, as well as themethods employed in their installation during immediate or subsequentdental placement and oral surgery exhibit several shortcomings. Inaddition, it would be advantageous to provide for the ability of apractitioner to manufacture his or her own healing caps exhibitingimproved characteristics.

BRIEF SUMMARY

The present invention is directed to casting jigs, methods, and kitsthat may be used in chair-side or small-scale manufacture ofcustomizable sculptable anatomical healing caps by a practitioner forinstallation into a patient. A casting jig may include a body having oneor more wells within the body, each well being open at a proximal endthereof and having a negative shape corresponding to an anatomicalhealing cuff body of a given tooth position. Each respective anatomicalhealing cuff body negative shape includes an asymmetrical cross-sectionand an irregular surface so that an anatomical healing cuff body havingsaid shape is configured to provide a substantially custom filling of atleast an emergence portion of a void where a natural tooth once emergedor should have emerged from the void (e.g., in the case of acongenitally missing tooth). The casting jig may further include asocket at a distal end of each well that is configured to releasablyreceive therein a dental implant or dental implant analog.

A related method of manufacture may include providing a casting jig(e.g., as described above). A dental implant or dental implant analogmay be releasably received within a corresponding socket of the castingjig. A curable or otherwise settable material is introduced into thewell of the casting jig (e.g., while in a flowable state), whichmaterial is allowed to set or cure so as to become rigid or hard. Uponsetting or curing, the resulting rigid material is in the shape of ananatomical healing cuff body having the desired asymmetricalcross-section and irregular surface so that the anatomical healing cuffbody is configured to provide substantially custom filling of at leastthe emergence portion of a void where a natural tooth once emerged orshould have emerged. The cured or set rigid anatomical healing cuff bodycan be easily removed from the casting jig for subsequent installationinto a dental implant which is in the jaw of a patient. In oneembodiment, the practitioner may further customize the anatomicalhealing cuff body by applying additional material thereto or removingmaterial therefrom (e.g., immediately prior to installation).

A related kit for use in manufacture of customizable sculptableanatomical healing caps may include a casting jig (e.g., as describedabove) and a curable or otherwise settable material for introductioninto a well of the casting jig to form an anatomical healing cuff bodyof an anatomical healing cap. Such a material may be flowable prior tosetting or curing, so as to allow its easy introduction into the wellprior to becoming rigid as a result of curing or setting.

Because the emergence portion of the various tooth positions are notidentical to one another (but they do remain substantially the same fromone person to another person when considering the same tooth position),different customizable sculptable anatomical healing caps can beprovided for the various tooth positions, which differ in the particularconfiguration of the enlarged cuff body of the respective healing cap.Use of such anatomical healing caps greatly improves the ability of thepractitioner to preserve desirable aesthetic and functionalcharacteristics of the gingival tissue surrounding the location of thedental implant and associated crown or other prosthesis.

Furthermore, the presently described casting jigs and associated kitsand methods allow a practitioner to manufacture such anatomical healingcaps himself or herself, e.g., within one's own office. This may allowthe practitioner to reduce costs associated with purchase of expensivestate of the art healing caps, while providing a superior product whichprovides an anatomical, improved fit for better preservation of thegingival tissue.

Another embodiment is directed to a casting jig system including acasting jig having a body including one or more wells, each being openat a proximal end thereof and having a negative shape corresponding tothe anatomical healing cuff body of a given tooth position. Eachnegative shape may include an asymmetrical cross-section and irregularsurface so that an anatomical healing cuff body having the shapeprovides substantially custom filling of at least an emergence portionof a void where a natural tooth once emerged from the void or where atooth would have emerged from the void. A socket may be provided at thedistal end of each well, and an opening may be provided in the bottomsurface of the casting jig for accessing the socket. An elongate handleis provided with the casting jig, which handle is insertable through anopening in the bottom surface of the casting jig, up into the socket atthe bottom of the well. The handle includes a recessed connection in adistal end thereof (e.g., similar to a dental implant analog). Thisallows a temporary abutment (e.g., commercially available) to beinserted into the well, and coupled into the distal end of the elongatehandle, within the jig. The temporary abutment may serve as a core aboutwhich the anatomical healing cuff body is to be formed, in the well, asa curable or otherwise settable dental material is introduced into thewell, around the temporary abutment core.

Once the cast anatomical cuff body hardens, a screw coupling the core tothe elongate handle may be backed out (e.g., through the hollowtemporary abutment core), and the elongate handle removed from below(through the opening in the bottom of the casting jig). The formedanatomical healing cap, including the anatomical cuff body may beremoved from above, through the open top of the well.

A crown forming jig and associated method for forming an inexpensive,chair-side prepared bis-acrylic (or other composite resin or othersettable material) temporary crown that may be easily and quicklyinstalled over the anatomical healing cuff body is also disclosed. Sucha crown forming jig may include a body including one or more wells inthe body, each well being open at a proximal end thereof and having anegative shape corresponding to a crown portion of a given toothposition. The body may further include a first portion of an alignmentmechanism disposed on or within the proximal top surface of the body ofthe crown forming jig. A slug including a displacement body (e.g.,formed of polycarboxylate) may also be provided, which slug includes thesecond portion of the alignment mechanism. An uncured bis-acrylicmaterial is introduced into the well, the displacement body of the slugis aligned over the crown forming casting jig body, and the two arebrought together. The displacement body penetrates the well, pushing thebis-acrylic or other material outwardly, towards the sidewalls of thewell. The alignment mechanism also serves as a stop to limit advancementof the displacement body into the well to a desired point, so as toensure that the resulting hollow crown is of the desired thickness oncethe bis-acrylic sets. The cured bis-acrylic or similar materialadvantageously will not bond to the polycarboxylate displacement body,allowing the formed hollow crown to be easily and quickly removed fromthe casting jig. The crown can be formed chair-side, and quicklyinstalled as a temporary crown over the anatomical healing cap. Anotherembodiment may be similar, but without use of the displacement body,resulting in a solid crown.

The present invention is also directed to methods of taking animpression or scan of a patient's oral cavity without requiring removalof a healing cap coupled within the implant in the subgingival void. Forexample, such a method may include providing an anatomical healing capreceived within the subgingival void of a given tooth position, wherethe anatomical healing cap is coupled into an implant disposed adjacent(e.g., over for a mandibular tooth position) the anatomical healing cap.A scanning body or an impression post is inserted into an open end(e.g., the hollow core) of the anatomical healing cap, in-situ, with theanatomical healing cap positioned in the subgingival void, and theimplant thereunder (or thereover for a maxillary tooth position). Suchallows the scanning body or impression post used as a reference inmaking the impression or scan to be inserted without first having toremove the anatomical healing cap. Such is advantageous as it thusprevents further collapse of the gingival tissue surrounding the voidthat may occur when removal occurs, and during any period where theanatomical healing cap were not in place.

The scanning body or impression post may be keyed to the interiorsurface of the healing cap (e.g., grooves and mating protrusions) toensure proper orientation of the scanning body, and to aid in ensuringthat the scanning body or impression post is fully seated to the bottomof the healing cap. Where a scan is being taken, radiopaque markers maybe provided within the anatomical healing cap and/or scanning body foruse as reference points when building the scanned model or image fromthe scan data.

Another method of taking a scan of a patient's oral cavity includesproviding an anatomical healing cap configured to be received within asubgingival void of a given tooth position, taking a first scan (e.g.,an extraoral scan) of the anatomical healing cap before seating theanatomical healing cap into the subgingival void of the given toothposition, seating the anatomical healing cap into the implant disposedadjacent the anatomical healing cap, and taking a second scan (e.g., anintraoral surface only scan) of the anatomical healing cap andsurrounding surfaces of the oral cavity, and then integrating the firstscan of the anatomical healing cap with the second scan of theanatomical healing cap and the surrounding surfaces into an overall oralcavity scan. Reference point(s) associated with the anatomical healingcap may be used to orient the two scans with one another (e.g.,superimposing one scan over the other), to integrate the two scanstogether.

Such a method eliminates the need for a scanning body used as areference point in the scanning, as it instead uses some structure(e.g., the connection portion) of the anatomical healing cap as such areference point instead, to precisely orient one scan (of the healingcap) over the second scan (a surface scan including the healing cap onceplaced, as well as the surrounding dentition. Such a scan can aid thepractitioner in fabricating a final restoration that will be replacingthe anatomical healing cap (which is typically in place for only amatter of weeks to about 4 months, as healing occurs). In someembodiments, this may provide the practitioner with all the informationneeded to correctly orient the apical portion of the restoration intothe implant. In another embodiment, an apical scanning body could beplaced in the implant (e.g., during the first or second scan), toprovide the needed reference point(s).

These and other advantages and features of the present invention willbecome more fully apparent from the following description and appendedclaims, or may be learned by the practice of the invention as set forthhereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

To further clarify the above and other advantages and features of thepresent invention, a more particular description of the invention willbe rendered by references to specific embodiments thereof, which areillustrated in the appended drawings. It is appreciated that thesedrawings depict only typical embodiments of the invention and aretherefore not to be considered limiting of its scope. The invention willbe described and explained with additional specificity and detailthrough the use of the accompanying drawings in which:

FIG. 1A is a perspective view of an exemplary upper dental arch;

FIG. 1B is a perspective view of the dental arch of FIG. 1A in which acentral incisor has been removed, leaving a void;

FIG. 1C is a perspective view of the dental arch of FIG. 1B in which adental implant surgical drill is used to prepare an anchor hole in theunderlying bone for anchoring a dental implant;

FIG. 1D is a perspective view of the arch of FIG. 1C as an implant isbeing inserted (e.g., with the aid of a transfer coping);

FIG. 1E is a perspective view of the arch and into the void showing theimplant anchored into the bottom of the void;

FIG. 1F is a perspective view of the arch showing a state of the arthealing cuff coupled into the implant;

FIG. 2A is an exploded perspective view of an exemplary anatomicalhealing cap configured for filling the emergence portion of the voidformed when an upper central incisor is removed or is missing;

FIG. 2B is an assembled perspective view of the anatomical healing capof FIG. 2A;

FIG. 2C is a side elevation view of the anatomical healing cap of FIG.2B;

FIG. 2D is a top view of the anatomical healing cap of FIG. 2B;

FIG. 2E is a cross-sectional view through the anatomical healing cap ofFIG. 2B;

FIG. 2F is a perspective view similar to that of FIG. 2B, but showing analternative configuration at the distal dental implant end;

FIG. 2G is a perspective view similar to that of FIG. 2B, but showinganother alternative configuration at the distal dental implant end;

FIG. 2H is a perspective view similar to that of FIG. 2B, but showing analternative configuration including a removable grippable handle;

FIG. 3A is an exploded perspective view showing a related systemincluding an anatomical healing cap and an associated temporary crownform;

FIG. 3B is a perspective view showing the system of FIG. 3A with thetemporary crown form coupled over the anatomical healing cap;

FIG. 4A is a perspective view showing a portion of the cuff body of thehealing cap being customized by removal with a dental burr;

FIG. 4B is a perspective view showing the cuff body being customized bybuilding up with application of a dental material;

FIG. 4C is a perspective view of the arch of FIG. 1E in which ananatomical healing cap has been coupled into the implant, leaving no gapbetween the cuff body of the healing cap and the gingival tissuesurrounding the emergence portion of the void;

FIG. 4D is another perspective view of the arch of FIG. 4C;

FIG. 4E is another perspective view of the arch of FIG. 4C in which atemporary crown has been formed over the healing cap;

FIG. 5 is a perspective view of an exemplary casting jig formanufacturing anatomical healing caps;

FIG. 6 is a cross-sectional view through the casting jig of FIG. 5;

FIG. 7 is a cross-sectional view similar to FIG. 6, but in which thedental implant analog and the implant housing have been removed from thesocket below the well of the casting jig;

FIG. 8 is a perspective view showing positioning of an elongate body(e.g., a straw, an implant wrench, a temporary abutment, etc.) into therecessed connection of the implant or implant analog and introduction ofthe curable or otherwise settable material around the elongate body soas to form an anatomical healing cuff body while preserving accessthrough the cuff body to the implant or implant analog;

FIG. 9A is a cross-sectional view through the casting jig of FIG. 8 asthe anatomical healing cap is being formed;

FIG. 9B is a cross-sectional view through the casting jig of FIG. 8 inwhich a temporary abutment is used as a core around which the anatomicalhealing cap is being formed;

FIG. 9C is a cross-sectional view through the casting jig of FIG. 8 inwhich a temporary abutment having a lower profile than that of FIG. 9Bis used as a core around which the anatomical healing cap is beingformed;

FIG. 9D is a cross-sectional view through the casting jig of FIG. 8,similar to that of FIG. 9B, but illustrating an alternative embodiment;

FIG. 10 is an exploded perspective view of the anatomical healing capmanufactured using the casting jig next to the associated implantanalog;

FIG. 11 is a view of an anatomical healing cap formed using the castingjig and a coupling screw as the elongate body;

FIG. 12 is a view of a pontic configured similar to the anatomicalhealing caps formed using the casting jig, but which does not include acentral access channel 138 or locking member 150;

FIG. 13A illustrates an exemplary elongate handle for insertion throughthe opening in the bottom surface of a casting jig during manufacture ofan anatomical healing cap;

FIG. 13B illustrates another exemplary elongate handle, similar to thatof FIG. 13A;

FIG. 13C illustrates another exemplary elongate handle, similar to thatof FIG. 13A, but with a generic recessed connection, rather than a keyedstructure;

FIGS. 14A-14B illustrate perspective and cross-sectional views,respectively, of an exemplary temporary abutment core;

FIGS. 14C-14D illustrate perspective and cross-sectional views,respectively, of an alternative exemplary temporary abutment core thanthat shown in FIGS. 14A-14B;

FIGS. 15A-15B illustrate perspective and cross-sectional views,respectively, of the temporary abutment core and an associated screw forretaining the core in the distal end of the elongate handle duringmanufacture of the anatomical healing cap;

FIGS. 15C-15D illustrate perspective and cross-sectional views,respectively, of the alternative temporary abutment core and anassociated screw for retaining the core in the distal end of theelongate handle during manufacture of the anatomical healing cap;

FIG. 16 illustrates a practitioner gripping the proximal end of theelongate handle with a temporary abutment core retained in the distalend thereof;

FIG. 17A illustrates the elongate handle and retained abutment coreinserted through the opening in the bottom surface of a casting jig,positioning the abutment core in the well of the jig;

FIG. 17B illustrates injection of a curable or settable material intothe well, surrounding the abutment core, which material hardens to formthe desired anatomical healing cuff body surrounding the abutment core;

FIGS. 18A-18B illustrate perspective and cross-sectional views,respectively of the formed anatomical healing cap separated from theelongate handle, as the screw is backed out, allowing the anatomicalhealing cap to be removed through the top of the well of the castingjig, and the elongate handle to be removed through the bottom of thecasting jig;

FIG. 19A illustrates the finished anatomical healing cap ready forplacement into the void where a tooth once emerged or would haveemerged;

FIG. 19B illustrates the finished anatomical healing cap (formed usingthe alternative abutment core) ready for placement into the void where atooth once emerged or would have emerged;

FIG. 20 illustrates how a curable or otherwise settable material may beinjected into a generic recessed connection of the handle, between thecircular wall of the handle and a keyed locking member of the abutmentcore inserted into the handle, converting the generic recessedconnection so as to be keyed to the particular abutment core insertedtherein;

FIGS. 21A-21C illustrate an exemplary crown forming casting jig for usein forming a bis-acrylic crown for placement over the anatomical healingcap;

FIG. 22A illustrates the crown forming casting jig of FIGS. 21A-21C withuncured bis-acrylic material placed in the well thereof;

FIG. 22B illustrates a polycarboxylate slug being pressed into the wellof the crown forming casting jig of FIG. 22A, seating the alignmentmechanism of the casting jig and slug, while displacing the bis-acrylicmaterial from the central portion of the well, so as to form abis-acrylic hollow crown;

FIG. 22C illustrates a cross-section through the finished hollow crownafter it has hardened and been removed from the casting jig;

FIG. 23 illustrates an exemplary bis-acrylic hollow crown after it hashardened and been removed from the casting jig;

FIG. 24A illustrates a scanning body or impression post being insertedinto an open end of an anatomical healing cap, such that the body orpost is atop the healing cap, and the healing cap is atop an implant,all in-situ;

FIG. 24B is a cross-sectional view of the stacked implant, anatomicalhealing cap, and scanning body as seen in FIG. 24A;

FIG. 24C illustrates a scanning body being inserted into an open end ofan anatomical healing cap formed using the alternative abutment core,such that the body or post is atop the healing cap, and the healing capis atop an implant, all in-situ;

FIG. 24D a cross-sectional view of the stacked implant, anatomicalhealing cap formed using the alternative abutment core, and scanningbody as seen in FIG. 24C;

FIGS. 25A-25B are perspective and cross-sectional views, respectively,of an anatomical healing cap, such as that seen in FIG. 24A;

FIGS. 25C-25D are perspective and cross-sectional views, respectively,of an anatomical healing cap formed using the alternative abutment core,such as that seen in FIG. 24C;

FIGS. 26A-26B are perspective and cross-sectional views, respectively,of an impression post or scanning body as seen in FIG. 24A;

FIGS. 26C-26D are perspective and cross-sectional views, respectively,of an impression post or scanning body as seen in FIG. 24C; and

FIG. 27 illustrates an alternative scanning body that is configured tomate with a locking member of the healing cap like the dental implant.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS I. Introduction

One problem with conventional healing caps and related methods of oralsurgery is that those features of the gingiva that provide much of thecharacteristic natural aesthetic appearance of natural teeth andadjacent gum tissue are almost always lost once a tooth is pulled andreplaced with a prosthesis. In particular, the gingival tissuesurrounding the crown of a natural tooth where it emerges (i.e., itsemergence profile) is lost during such procedures.

The gingival cuff refers to the generally scalloped pattern of thegingival tissue that is most prominently seen along the buccal surfaceof the teeth. The height of contour of the gingival cuff refers to thedifference between the most occlusal extension of the gingiva (i.e.,between teeth) as compared to its location at the center of a tooth.Generally, the height of contour of the gingival cuff is greatest at alocation between two adjacent teeth. In other words, the location of thegingival cuff extends occlusally to its greatest extent at this locationbetween the teeth. At a location corresponding to a buccal center faceof a tooth, the location of the gingival cuff exhibits its lowestocclusal extension.

When a natural tooth is pulled and eventually replaced with a customcrown or other prosthesis, much of the dynamic range of the previousheight of contour is lost because the gingival tissue between adjacentteeth recedes, and is lost.

Gingival tissue disposed between adjacent teeth is often referred to asthe interdental papilla. This tissue resides between the void resultingfrom the pulled tooth and the adjacent remaining tooth. As a result ofthe loss of the tooth, the interdental papilla may atrophy and fill thevoid over time. As a result, much of the interdental papilla tissue,particularly the initial and desirable aesthetic characteristics of thistissue, also tends to be lost upon removal of the natural tooth.

At the extreme gingival edge of the gingival cuff there is gingivaltissue that overlies the underlying jaw bone. This gingival tissuetypically exhibits a prominence in the buccal direction (i.e., it sticksout or protrudes bucally) and is often referred to as buccal prominence.While the gingival tissue over this bony tissue is not necessarily lost,the prominence by which the tissue sticks out bucally is typically lostwhen a natural tooth is pulled.

The present invention is directed to devices, kits, and methods allowingsmall-scale manufacture of customizable sculptable anatomical healingcaps, allowing the practitioner to chair-side manufacture the neededanatomical healing caps for use with any given patient. Because thehealing caps anatomically match the given tooth position where they areplaced, they provide custom filing of at least the emergence portion ofthe void resulting from removal of a selected tooth (or where a toothshould be in the case of a congenitally missing tooth). Because of theanatomical features of the healing cap, use of the healing capadvantageously allows the practitioner to better preserve the desirableaesthetic features of the gingival tissue surrounding and associatedwith natural teeth.

FIGS. 1A-1F illustrate an upper dental arch, as well as typical stepsemployed in removal of a tooth, installation of an implant, andplacement of a state of the art healing cuff or cap. For example, FIG.1A shows a person's upper dental arch 100 including central incisors102. Also apparent in FIG. 1A is the gingival cuff 104 where the naturalteeth emerge from the gingival tissue, and the typical height of contourwhere the highest contour H₂ is between two adjacent teeth, while thelowest contour or point along the gingival cuff is H₁, at the center ofthe buccal face of the teeth. The difference H between H₂ and H₁represents the height of contour associated with the natural teeth andgingival cuff prior to removal of the natural tooth.

In addition to the gingival cuff, a buccal prominence 106 is associatedwith the gingival edge of gingival cuff 104, disposed gingivallyrelative to the crown of each respective tooth (e.g., labeled buccalprominence 106 corresponds to tooth 102). FIG. 1B shows the dental arch100 after central incisor 102 has been removed, leaving a void 108 onceoccupied by the root of tooth 102. The top or most gingival portion ofvoid 108 is the emergence portion 110 of void 108, whose contours aredefined by the shape of the emergence portion of the tooth 102, justbelow the crown portion of the tooth. Also apparent in FIG. 1B is theinterdental papilla 112.

As shown in FIG. 1C, the void 108 is prepared to receive a dentalimplant 114 by drilling into the bone tissue of the underlying jaw boneat the bottom of void 108, after which a dental implant 114 may beinserted therein, as shown in FIG. 1D-1E. FIG. 1D shows a transfercoping 115 or similar structure being used to aid in seating the implant114 into void 108. FIG. 1E illustrates a view down into void 108 oncedental implant 114 has been fully seated within the prepared underlyingbony tissue (and transfer coping 115 has been uncoupled from implant114). Much of the lower portion of void 108 may be filled by dentalimplant 114, while the emergence portion 110 remains unfilled. FIG. 1Fshows installation of a state of the art healing cap or cuff 116, whichcouples into dental implant 114. Healing cap or cuff 116 is typicallyprovided in various sizes, each of which is cylindrical (e.g., each of adifferent diameter and/or height). A healing cap or cuff is selectedfrom the available sizes and coupled into dental implant 114. Healingcap or cuff 116 may remain in place for several weeks (e.g., 1.5 to 6months) while the site heals. As shown in FIG. 1F, because the healingcap or cuff 116 is not anatomically shaped to fill the emergence portion110 of void 108, gaps 118 remain between healing cap or cuff 116 and thegingival walls defining emergence portion 110. Placement of the healingcap or cuff 116 may be the end of what is termed the first stageprocedure. It will be understood that while described in terms ofvarious stages, healing caps or cuffs 116 may be placed in various otheroral surgery procedures (e.g., second stage, immediate placement,subsequent placement, etc.). Similarly, the inventor's anatomicalhealing cap devices, systems and methods may be employed in various oralsurgery procedures (e.g., during a first or second stage procedure, inan immediate placement procedure, in a delayed placement procedure, orin any other appropriate oral surgery procedure). The greatest benefitmay be obtained where the anatomical healing cap devices are placedimmediately or soon after placement of the implant, so that the gingivaltissue is immediately supported, and loss of desired gingival tissuefeatures is minimized.

By way of example, in a subsequent second stage procedure, after ahealing period of at least several weeks, the person may return to thepractitioner's office, the healing cap or cuff 116 may be removed, and apermanent prosthesis may be installed by coupling into implant 114.During the healing period, the gingival tissue surrounding healing capor cuff 116 progressively adapts to the shape provided by healing cap orcuff 116, collapsing into, growing into, or otherwise filling gaps 118.In addition, the height of contour of the gingival cuff tends to becompressed (i.e., reduced) as the tissue between adjacent teeth recedes,the interdental papilla fall or otherwise fill gaps 118, and the buccalprominence 106 recedes so as to be less prominent bucally. As a result,the emergence profile and other desirable gingival features arecompromised. At this stage, even if one were to install a crown or otherprosthesis that were a perfect match to the natural tooth, including thesubgingival emergence portion, it is often too late to recapture theprior characteristics of the surrounding gingival tissue, which havebeen lost. Furthermore, when installing such a prosthesis at this laterstage, the gingival tissue that has grown into gaps 118 is often cutaway or compressed in order to make space for the prosthesis. Suchactivity can lead to subsequent necrosis of the gingival tissue.

Customizable sculptable anatomical healing caps specifically configuredto preserve or restore or create (in the case of missing teeth) as muchof this gingival tissue, its emergence profile, and other features aspossible are disclosed in the inventors' earlier U.S. patent applicationSer. No. 13/347,127 filed Jan. 10, 2012 and entitled CUSTOMIZABLESCULPTABLE ANATOMICAL HEALING CAPS, SYSTEMS, AND RELATED METHODS, aswell as U.S. Pat. No. 10,016,260, each of which is herein incorporatedby reference in its entirety. The present application discloses castingjigs, and related kits and methods for use in manufacture of theanatomical healing caps. The casting jigs, kits, and methodsadvantageously allow a practitioner to manufacture such anatomicalhealing caps himself or herself. Manufacture may be easily achievedchair-side, on a small scale, or both. Of course, such casting jigscould also be employed in a large-scale manufacture process.

III. Exemplary Customizable Sculptable Anatomical Healing Caps

FIGS. 2A-2E illustrate various views of an exemplary sculptableanatomical healing cap 130 a configured to fill the emergence portion ofa void resulting from removal of an upper central incisor. Sculptableanatomical healing cap 130 a includes an elongate body 132 extendingbetween a proximal end 134 and a distal dental implant insertion end136. Body 132 may be advantageously hollow, including a hollow channel138 with open ends and extending generally along longitudinal axis A soas to allow insertion of coupling screw member 140 into hollow channel138, by which external threads 142 can be coupled into correspondinginternal threads of a dental implant 114.

Sculptable healing cap 130 a advantageously includes an enlarged cuffbody 144 a extending laterally outward from hollow elongate body 132. Inone embodiment, body 132 and body 144 a are integral. In other words,they may be one and the same, such that no separate body 132 is present.This is particularly so where the cuff body 144 a is formed by casting acurable or otherwise settable dental material within a casting jig. Ofcourse, a separate body 132 may be provided in such a casting jigmanufactured embodiment, by casting the cuff body about body 132 (e.g.,body 132 may initially comprise a straw or temporary abutment insertedinto the well of the casting jig, about which the cuff body 144 a isformed. Enlarged cuff body 144 a is disposed between proximal end 134and distal end 136, and advantageously is shaped, as manufactured, toprovide a substantially custom fit so as to fill emergence portion 110of void 108. In the illustrated configuration, cuff body 144 a includesa subgingival or lower portion 146 a and an exposed or upper portion 148a. Subgingival portion 146 a becomes inserted within emergence portion110 of void 108 during use, while exposed portion 148 a residesgingivally above void 108.

Both portions 146 a and 148 a may be shaped to mimic the shape of thenatural tooth which may have immediately prior resided within void 108.In particular, subgingival portion 146 a is shaped to mimic that portionof the natural tooth which resides immediately below the gingivalsurface, so that this portion 146 a mimics the emergence portionincluding the emergence profile of the natural tooth. In order to mimicthe natural tooth contours just below the gingival surface, thesubgingival portion 146 a includes an asymmetrical cross-section and anirregular surface which mimic the emergence portion and emergenceprofile of the natural tooth. This allows portion 146 a to providesubstantial custom filling of emergence portion 110 of void 108resulting from removal of an upper central incisor 102.

Portion 148 a may also be shaped to mimic the shape and contour of thenatural tooth, although portion 148 a resides above void 108. Theemergence profile is defined by the interface between the subgingivalportion 146 a and exposed portion 148 a. In some embodiments, exposedportion 148 a may be omitted, although it may be preferable to includean exposed portion so as to provide a surface that extends somewhatabove the gingival tissue around the emergence profile, to betterpreserve the natural features of the emergence profile gingiva. Forexample, this provides support structure against which the gingivaltissue can be supported and prevented from collapsing, even where theparticular person's emergence profile may differ somewhat from the asmanufactured subgingival portion 146 a that approximates a custom fit.In one embodiment, the exposed portion 148 a does not extend occlusallyto the same extent that a normal natural tooth would. For example,occlusal features, including cusp features of the natural tooth maysimply be omitted (e.g., the occlusal or top surface of the exposedportion 148 a may simply be a generally flat surface, with a holetherein where hollow channel 138 intersects the generally flat surface.

In one embodiment, hollow channel 138 of body 132 may be bounded by acylindrical or other shaped wall, which may or may not extend proximallyabove exposed portion 148 a.

At least subgingival portion 146 a of cuff body 144 a comprises asculptable material so that a practitioner can easily remove selectareas of portion 146 a, can add to (i.e., build up) portion 146 a with adental material that will adhere (e.g., a curable dental material), orboth so that portion 146 a can be chair-side fully customized to providean exact, custom fit that fills emergence portion 110 of void 108.Sculptability is advantageous because while the shape and size of theemergence portion 110 of void 108 is more or less the same for differentpersons for a particular given tooth position (e.g., generally allpersons will have very similar emergence portions for their uppercentral incisors), individual people do vary somewhat from individual toindividual, and the ability to easily remove material, add material, orboth relative to portion 146 a allows the practitioner to fullycustomize portion 146 a for a given emergence portion 110 of void 108.

Of course, in some embodiments, more than a single size cuff body may beprovided for any given tooth position. For example, children may exhibitdifferently sized emergence portions as compared to adults for a giventooth position. Similarly, some individuals may have particularly largeor small teeth, so that their emergence portions may vary somewhat fromthe normal or average size. As such, in one embodiment, different sizes(e.g., normal adult size, a “large” adult size, a “small” adult size,and/or a child size) may be provided, such that the practitioner maychoose the most appropriate size, which may then be fully customized bysculpting. Such differences in sizing can be provided within the castingjigs of the present invention. Because the cuff body is sculptable, apractitioner may simply add to or remove material as needed to achievethe desired size.

In one embodiment, subgingival portion 146 a may intentionally be sizedto be slightly larger than the typical average emergence profile, sothat the practitioner may shave or otherwise remove portions therefrom(e.g., with a dental burr, scalpel or other suitable tool) immediatelyprior to placement. This may be advantageous as it may be easier andless time consuming to typically require removal of material rather thansupplementation, where material must be added to fully customize thesubgingival portion 146 a. In some embodiments, it may be expected thatlittle or no modification (either removal or adding to) may be required.As such, the size and shape provided is already substantially configuredto fill the person's emergence portion 110 of void 108 (withsubstantially no gaps), providing the same emergence profile as wasprovided by the natural tooth to thereby support the gingival tissue.

In one embodiment, the subgingival portion 146 a, and preferably theentire cuff body 144 a is therefore not formed of metal, but comprises amaterial that may be easily and conveniently shaved or cut away, as wellas added to. Such suitable materials include any of various plasticmaterials, dental composite materials, or other materials that can bereadily customizable through use of a dental burr, scalpel, or othersuitable tool. When manufactured with use of the present inventivedental jigs, cuff body 144 a may be formed from a curable or otherwisesettable dental material (e.g., dental composite, etc.) that may bedispensed into the well of the casting jig so as to form the desiredcuff body 144 a. In one embodiment a radiopaque filler may beincorporated into the plastic or composite so that the subgingivalstructures of the healing cap can be viewed by x-ray or other imagingtechnique. Such materials also advantageously will readily bond tocurable or other suitable adhering dental materials applied theretowhere it is desired to add size or adjust contour to the asmass-manufactured cuff body. In one embodiment, the entire elongate bodyand enlarged cuff body may comprise a single piece of material (e.g.,plastic or composite material).

In one embodiment, the exterior surface of cuff body 144 a, particularlysubgingival portion 146 a, may be treated for stimulation of bone orother tissue growth. For example, the material of body 144 a or portion146 a may be particularly selected so as to stimulate growth (e.g., acalcium containing material such as hydroxyapatite or similar bonegrowth promoting material), or the surface may be mechanically (e.g.,roughened, smoothed, specific texture patterned), chemically, orotherwise treated to stimulate desired growth. While stimulation of bonegrowth may be desired, in another embodiment, material selection ortreatment may be specifically configured to promote soft tissue growth.

In one embodiment, the distal dental implant insertion end 136 ofsculptable anatomical healing cap 130 a may include a locking member 150with a non-circular perimeter configured for insertion into acorrespondingly shaped proximal end of a dental implant 114. In theillustrated configuration, the locking member 150 is hexagonal. Otherconfigurations similarly configured to lock against rotation will bereadily apparent to one of skill in the art (e.g., triangular, 4-sided,5-sided, use of non-circular curved sides (e.g., an oval), combinationof straight and curved sides, etc.). This locks the healing cap 130 aagainst rotation once inserted within dental implant 114. Any suitableanti-rotation locking mechanism, including those proprietary to variousdental implant manufacturers within the art, may be employed. Indeed, aswill be explained below, the casting jigs of the present invention mayprovide for the ability to cast such a proprietary shaped lockingmechanism as a part of the as manufactured healing cap through use of acorresponding dental implant during casting.

In another embodiment, the distal dental implant insertion end 136 mayinclude a circular locking member 150′ (see FIG. 2F). In anotherembodiment, no locking member at all is provided (see FIG. 2G). Any suchembodiments may be prepared through use of the inventive casting jigs.In the embodiment of FIG. 2G, external threads 142 are simply coupledinto corresponding internal threads of dental implant 114, and the shapeof subgingival portion 146 a itself can serve to prevent rotation, asthis portion is non-circular and engages against the gingival tissuebounding emergence portion 110 of void 108. Other coupling mechanismsbetween the healing cap and dental implant 114 are possible. Forexample, the location of internal and external threads may be switched(i.e., internal threads on healing cap, and corresponding externalthreads on dental implant). Various other suitable coupling mechanismswill be apparent to one of skill in the art in light of the presentdisclosure.

In one embodiment, a removable grippable handle may be provided at theproximal end 134 of body 132. As shown in FIG. 2H, a grippable handle152 may be provided. Handle 152 may include a shaft 154 extendinglaterally outwards from elongate body 132, cuff body 144 a, or both. Inone embodiment, shaft 154 may be disposed adjacent the buccal surface ofbody 132, cuff body 144 a, or both, which advantageously orients thehandle in the most suitable position during insertion into void 108. Asshown, handle 152 may be generally T-shaped, including a cross-bar 156atop or near end of shaft 154. Another shaft 154′ may be providedopposite shaft 154, providing two points disposed laterally outward foreasy gripping. Shaft 154, shaft 154′ and/or cross-bar 156 providesurfaces that can be easily gripped by dental pliers or another suitabletool available to the practitioner. Shaft 154′ and T-shaped handle 152may be cast in the inventive casting jig by simply providing theseextensions at a top surface of the well used in forming the cuff body,as will be shown and described below in conjunction with FIG. 5. Oncethe healing cap is placed within void 108, handle 152 (including shaft154′) may be removed (e.g., cut away).

While the illustrated configuration is shown with cuff body 144 agenerally aligned with axis A of channel 138, in another embodiment, theaxis A of channel 138 may be offset relative to an axis of cuff body 144a. Similarly, cuff body 144 a may not be “on center” relative to axis Aof threaded portion 142. This may be beneficial where the natural tooth(and thus void 108) is mis-aligned relative to what would be “normal”.Such configurations allow the practitioner to account for suchsituations.

It will be understood that anatomical healing caps may also be providedfor other tooth positions, such as upper lateral incisors, uppercuspids, upper bicuspids, upper molars, lower incisors, lower cuspids,lower bicuspids, and lower molars. It will be apparent that a singleconfiguration may sometimes be suitable for two or more different toothpositions (e.g., a single bicuspid configuration may be used for bothfirst and second bicuspids, a single molar configuration may be used forboth first and second molars, a single lower incisor configuration maybe used for all lower incisors, etc.). Additional details of theanatomical healing caps are disclosed in U.S. patent application Ser.No. 13/347,127 filed Jan. 10, 2012 and entitled CUSTOMIZABLE SCULPTABLEANATOMICAL HEALING CAPS, SYSTEMS, AND RELATED METHODS, as well as U.S.Pat. No. 10,016,260, each of which is already incorporated by referencein its entirety.

FIGS. 3A-3B illustrate healing cap 130 a of FIG. 2B in combination witha temporary crown form 160 that may be used with the healing cap inchair-side manufacture and placement of a temporary provisional crown orother prosthesis.

FIGS. 1A-1E discussed above show the same steps to be taken wheninstalling the anatomical healing caps. As shown in FIGS. 1A-1E, thetooth is removed, the void 108 is prepared to receive dental implant114, and dental implant 114 is anchored into the underlying bony tissueof the jaw bone. Rather than installing the cylindrical state of the arthealing cap or cuff shown in FIG. 1F, the appropriate sculptableanatomical healing cap is selected (e.g., healing cap 130 a configuredfor filling the emergence portion 110 of void 108 of an upper centralincisor).

The as manufactured shape and contours, which are a very close fit tothe actual emergence portion 110 and emergence profile of the void 110and tooth 102, may be custom modified as shown in FIG. 4A by removingselect portions of cuff body 144 a (particularly subgingival portion 146a) with a dental burr 180 or other suitable tool. As shown in FIG. 4B,if necessary, the practitioner may build up portions of cuff body 144 a(particularly subgingival portion 146 a) by applying and curing a dentalmaterial (e.g., light-curable, chemically-curable, heat curable, orother adhering dental material) 182. This is possible because at leastthe subgingival portion 146 a of cuff body 144 a is formed of a curableor otherwise settable material that is easily removed with the aid of adental burr 180 or similar tool. Similarly, the material of body 144 astrongly bonds to curable material 182, should such additions bedesired. For example, one may employ the same curable or otherwisesettable dental material employed in casting the cuff body 144 a in thecasting jig to add material, if desired. By removing material, addingmaterial, or both, the practitioner is advantageously able to relativelyquickly customize at least the subgingival portion 146 a of the cuffbody 144 a so that it provides a perfect or near perfect fit, fillingthe emergence portion 110 of void 108, with substantially no gaps.

As shown in FIG. 4C, the healing cap 130 a is placed within void 108 sothat subgingival portion 146 a fills the emergence portion 110 withsubstantially no gaps, and provides an emergence profile between thegingival tissue emergence portion 110 that is substantially identical tothat provided by the natural tooth prior to its removal. The exposedportion 148 a resides just above the gingival tissue, which is helpfulin ensuring that all gingival tissue is fully supported, particularlywhere there may be some small degree of variability in the contours ofthis gingival tissue between one patient and another for a given toothposition.

FIG. 4D shows the exposed portion 148 a having been completely removed(e.g., it may be easily cut away with a burr or other convenient dentaltools if desired). This view perhaps best shows how the emergenceprofile 111 surrounding the location where the healing cap 130 a emergesfrom the void 108 is perfectly or nearly perfectly matched to thegingival tissue so that substantially no gaps are present (compare withthe gaps that are common with state of the art healing caps shown inFIG. 1F). Because subgingival portion 146 a is provided with theanatomical shape of the emergence portion 110 of void 108, the variouscharacteristic features of gingival cuff 104 are preserved, includingpreservation of the full height of contour of gingival cuff 104, theinterdental papilla 112, and the buccal prominence 106.

As shown in FIG. 4E, a temporary or provisional crown 190 may bechair-side formed over the sculptable anatomical healing cap 130 a,while preserving access to underlying hollow channel 138 of healing cap130 a.

When a permanent crown (typically custom prepared in an off-site dentallab) is ready for installation, the healing cap (and any temporary crownformed thereon) may simply be removed from void 108 by accessingcoupling screw member 140 through hollow channel 138. The permanentcrown may then be inserted within void 108, taking the place of healingcap 130 a. Of course, the permanent crown may be provided with thenecessary shape to fill emergence portion 110, so that the gingivaltissue surrounding void 108 which has been preserved through the use ofsculptable anatomical healing cap 130 a can continue to be preserved.

The use of the anatomical sculptable healing cap provides for thepreservation of various gingival features that are characteristic ofnatural teeth, including the gingival cuff, height of contour, theemergence profile, the interdental papilla, and the buccal prominence.These features are typically progressively lost over the weeks and/ormonths following first stage treatment where insufficient structure isprovided for supporting the gingival tissue at the site where the toothonce was. Use of the healing caps, systems, and methods allow thesefeatures to be maintained, rather than progressively lost followingfirst stage treatment and before placement of a custom permanent crown.

III. Exemplary Casting Jigs

FIG. 5 shows an exemplary casting jig 200 for use in manufacture of thecustomizable sculptable anatomical healing caps. Casting jig 200includes body 202, which includes one or more wells 204 formed therein.Each well 204 is open at a proximal end 206 and may include a socket 210at a distal end 208 (FIG. 6). Open proximal end 206 allows introductionof a curable or otherwise settable dental material from which ananatomical healing cuff body (e.g., body 144 a) is formed. Distal end208 may include a socket 210, which allows a dental implant or dentalimplant analog 212 to be releasably received therein. Each well 204includes a negative shape corresponding to an anatomical healing cuffbody of a given tooth position. As described above relative to theanatomical healing caps and cuff bodies, each such correspondingnegative shape has an asymmetrical cross-section and an irregularsurface so that an anatomical healing cuff body having said shape (andformed by filling said well with a curable or otherwise settable dentalmaterial) is configured to provide substantially custom filling of atleast an emergence portion of a void where a natural tooth once emergedfrom a void or where a tooth would have emerged from a void.

Casting jig 200 is shown as including a plurality of wells, eachdifferently configured. For example, one or more wells may be configuredto produce healing caps configured for molar placement, one or more maybe configured to produce healing caps configured for bicuspid placement,one or more may be configured to produce healing caps configured forcuspid placement, one or more may be configured for upper lateralincisor placement, one or more may be configured for upper centralincisor placement. Similarly, wells may be configured to produce healingcaps specifically configured for placement in the various lower toothpositions. By way of example, one casting jig may include all the neededwells for producing all of the upper tooth positions, while a separatecasting jig may be provided for producing all of the lower toothpositions. In another embodiment, all positions may be provided within asingle casting jig. In another embodiment, only a single well may beprovided in a casting jig, specific to tooth configuration. Thus, itwill be readily apparent that any number and configuration of wells maybe provided within the inventive casting jigs.

While FIG. 6 shows an embodiment in which well 204 is vertically alignedover implant or implant analog 212, this is not required. For example,in some embodiments, a longitudinal axis of healing cuff body 144 a (andthus well 204) may be off center and/or out of axial alignment relativeto the longitudinal axis of implant or implant analog 212. Such offcenter or out of axial alignment configurations may be desirable whereteeth are crowded, or where space for anchor placement is otherwise notoptimal (e.g., where the void for implant placement is not axiallyaligned and centered below the healing cap to be placed). Suchconfigurations provide flexibility in void preparation and implantplacement to the practitioner.

As seen in FIG. 6, implant or implant analog 212 may be retained withinsocket 210 in the desired position and orientation relative to well 204by an implant housing 214 that serves as a cage, holding implant orimplant analog 212 in place. As perhaps best seen in FIG. 6, casting jig200 may include an upper portion 216 and a lower portion 218. Upperportion 216, which defines at least a portion of well 204, may be formedof any suitable material (e.g., plastic, metal, stone, an elastomericmaterial, etc.). In one embodiment, upper portion 216 is formed of anelastomeric material (e.g., rubber, silicone, etc.) so as to provideupper portion 216 adjacent well 204 with the ability to “give”,facilitating easier removal of a cast healing cap (e.g., cap 130 a). Inanother embodiment, upper portion may comprise a more rigid material(e.g., rigid plastic, stone, metal, etc.). Use of an elastomericmaterial may facilitate easier removal of cast healing caps from wells204, and may also prevent or otherwise minimize any tendency of upperportion 216 adjacent wells 204 to chip or crack, which might otherwisetend to occur with some materials (e.g., stone).

Lower portion 218 may be formed of the same or a different material ascompared to upper portion 216. In one embodiment, lower portion 218 maycomprise a material that is more rigid than upper portion 216. Forexample, lower portion 218 may comprise stone, metal, or a rigidplastic, while upper portion 216 may comprise an elastomeric material.

Another embodiment may not necessarily include discrete upper and lowerportions formed of different materials, but may include an elastomericmaterial surrounding wells 204 (although the entire upper portion 216may not be formed of the elastomeric material). In other words, portionsof casting jig 200 adjacent to wells 204 (and defining the bounds ofwells 204) may comprise an elastomeric material, while other portions ofcasting jig 200 may be formed of a more rigid material. In one suchembodiment, the elastomeric material may be surrounded by the more rigidmaterial.

Implant housing 214 advantageously holds implant or implant analog 212in a desired position and orientation relative to distal end 208 of well204. Implant housing 214 may also advantageously allow removal andinterchange of one implant or implant analog 212 with another implant orimplant analog. For example, there exist scores of dental implantmanufacturers, each often including proprietary structural features(e.g., proprietary locking recess shapes). In addition, where a healingcap is to be seated within and coupled to a given implant, the healingcap should preferably have corresponding shaped locking structure tocorrespond to that of the implant. For this reason, one typicallypurchases implants and healing caps from the same manufacturer so thatthey are compatible with one another. Because the present casting jigsallow a practitioner to manufacturer their own anatomical healing caps,it would be advantageous to provide a mechanism by which the anatomicalhealing caps may be manufactured so as to be compatible with a desiredmanufacturer implant to be employed. Use of the manufacturer's implantor implant analog in socket 210 of casting jig 200 provides the producedhealing cap with the desired corresponding locking structure (e.g.,locking member 150 of FIG. 2A).

Implant housing 214 allows one to remove implant or implant analog 212through an opening 221 in bottom surface 220 of casting jig 200, afterwhich an implant or implant analog of another manufacturer may beinserted into socket 210, housed within implant housing 214. Thus, thepractitioner or other user of casting jig 200 is free to employwhichever implant or implant analog manufacturer he or she desires.Placement of the desired implant or implant analog 212 within socket 210allows one to cast the produced healing cap so as to include the desiredlocking structure that corresponds to locking recess 225 of implant orimplant analog 212.

Separate, specifically configured implant housings may be provided foreach implant. For example, the exterior surface and profile of eachimplant or implant analog 212 may differ from manufacturer tomanufacturer. Thus, a different implant housing may be provided for eachmanufacturer's implants and implant analogs. Different, specificallyconfigured implant housings 214 may be provided to correspond to eachimplant or implant analog. For example, an interior profile 222 of agiven implant housing 214 may be specifically configured to mate with orotherwise retain the corresponding implant or implant analog 212. Theexterior profile 224 of all implant housings 214 may be identical,allowing any of the implant housings to be inserted into socket 210, foruse within casting jig 200 for a desired tooth position. Thus, thesystem allows one to employ any of dozens of various implant or implantanalog configurations (e.g., all configured for use with a given toothposition) within the socket adjacent the well configured to produce ahealing cap for that given tooth position.

In another embodiment, implant housing 214 may be suitable for useacross multiple differently configured implants or implant analogs 212.For example, where implant housing 214 is formed of an elastomericmaterial, so long as the various implants or implant analogs includeroughly similar sizing, the elastomeric deformation ability of theimplant housing 214 may allow housing 214 to deform to accept andappropriately “cage” similar, but differently configured implants orimplant analogs 212.

The configuration of casting jig 200 thus provides great flexibility inallowing the practitioner to manufacture anatomical healing caps for usewith any desired dental implant. All that is required is that the userinsert the desired implant or implant analog 212 into socket 210 (withaccompanying housing 214), and the formed anatomical healing cap willautomatically include the necessary structural features so as to allowits use with that particular implant.

Stated another way, while currently a practitioner is required topurchase healing caps from a manufacturer for perhaps as much as $40 to$80 each, the casting jig allows one to make their own healing caps,reducing the cost of components to be purchased. In addition, thepractitioner manufactured anatomical healing caps provide vastlyimproved results with respect to preservation of the desirable aestheticgingival features as compared to existing healing caps. All this ispossible at substantially reduced cost. For example, a practitioner maymake his or her own anatomical healing cap for significantly reducedcost as compared to the large purchase price of an inferior state of theart healing cap.

For example, implants typically include an anti-rotational lockingrecessed connection 225 (e.g., a hex recess) in the head of dentalimplant or implant analog 212. No matter the specific configuration ofsuch a proprietary locking recess of a given implant or implant analog,the produced healing cap can be formed so as to include thecorresponding mating feature as a result of the locking recess of theimplant or implant analog being used to close the distal end of well 204during casting. In other words, the shape defined by locking recessconnection 225 can be cast into the distal end of the manufacturedhealing cap. By way of example, if a given dental implant or implantanalog 212 includes a hex recess (e.g., recessed connection 225), theformed anatomical healing cap will include the corresponding hex lockingmember 150 (see FIG. 2A) at its distal end, as a result of the curableor otherwise settable material being introduced into the hex recess 225of the implant as well as the adjacent well 204, disposed thereabove. Aswill be described below, insertion of an elongate body (e.g., a wrench,a Q-tip, a hollow straw or other suitable tool) can be used to form andpreserve a hollow access channel 138 through the practitionermanufactured healing cap to allow subsequent coupling of the producedhealing cap to a dental implant with a screw 140.

While shown with implant housing 214, it will be understood that in someembodiments, implant or implant analog 212 may be directly retained bythe exterior walls and any retaining features (e.g., a snap fit, etc.)of socket 210. In another embodiment, retention of dental implant ordental implant analog 212 by socket 210 is indirect, (e.g., throughimplant housing 214), as described above in conjunction with FIGS. 6-7.Other retention mechanisms may alternatively be employed to releasablyretain dental implant or implant analog 212 within socket 210, and suchmechanisms are within the scope of the present invention.

For example, in one embodiment, the socket may include an elastomericlining, so as to allow one to simply press a desired implant or implantanalog 212 through opening 221 in bottom surface 220 up into positionrelative to well 204. Such a configuration may appear similar to thatshown in FIG. 6, but in which implant housing 214 is glued or otherwisefixedly retained within socket 210. The bottom portion of housing 214shown closed in FIG. 6 (where the two halves of housing 214 cometogether) might be open, allowing one to insert therein a desiredimplant or implant analog 212. The elastomeric nature of such a liningor housing may hold the implant or implant analog 212 in place duringcasting.

Housing 214 may include a projection (e.g., an annular ring) 226 thatsnap fits within a corresponding annular groove 228 formed within socket210 in lower portion 218. Other retention mechanisms for retaininghousing 214 within socket 210 will be apparent to one of skill in theart. In a similar manner, interior surface 222 of housing 214 mayinclude a projection 230 configured to snap fit within a correspondingannular groove 232 formed within implant or implant analog 212. Wherehousing 214 comprises an elastomeric material, no specific couplingstructure (e.g., projection 230 and corresponding groove 232) may berequired, as the elastomeric characteristics of housing 214 may besufficient to grip and hold the exterior surface of implant or implantanalog 212 in place, particularly once the assembly (implant analog 212and housing 214) is inserted into socket 210. Similarly, such grippingcharacteristics of implant housing 214 or of adjacent lower portion 218may be sufficient to hold implant housing 214 and implant or implantanalog 212 within socket 210 by friction fit, so that no annular ring226 or corresponding groove 228 may be present.

Housing 214 may include a handle adjacent bottom surface 220 or othermeans to facilitate gripping and removal of housing 214 from socket 210.For example, in the illustrated configuration, socket 210 widensadjacent bottom surface 220 at 234, allowing one to grip the exteriorsides 224 of housing 214 and pull it out of socket 210. Such anembodiment may advantageously preserve the ability of casting jig 200 tolay flat (e.g., bottom surface 220), without any handles extendingbeyond bottom surface 220. Another embodiment may include one or moregrippable handles on a bottom surface of housing 214, which handles maybe recessed within socket 210, so as to preserve the ability of thecasting jig to lay flat.

FIGS. 8-9A illustrate introduction of curable or otherwise settabledental material 236 into well 204. Prior to introduction of flowabledental material 236 into well 204, an elongate body (e.g., wrench 238)may be inserted into screw 140, which prevents flowable dental material236 from filling threaded portion 227 of implant or implant analog 212.In another embodiment, where no screw is present, the elongate body maybe directly inserted into threaded portion 227. For example, elongatebody 238 may have a diameter or thickness adjacent its distal end thatis sized so as to cover or plug threaded portion 227, while not being solarge in diameter or thickness to cover or plug the entirety of recessedconnection 225. In either case, as perhaps best seen in FIG. 9A,flowable dental material 236 may be allowed to enter recessed connection225 so that the produced healing cap includes a hexagonal locking member150 (or other anti-rotational shape), but in which the central portionof the locking member 150 is hollow, preserving hollow access channel138 therethrough. FIG. 10 shows a produced healing cap 130 a, inexploded view with coupling screw 140 and implant analog 212. Where ascrew is present, the screw may actually become integral with thehealing cap, so that it cannot be later removed (e.g., similar to asshown in FIG. 11). Once material 236 is cured, backing out of screw 140with wrench 238 may serve to unseat healing cap 130 a from well 204.

While the method is illustrated in FIG. 9A with elongate body 238comprising an implant wrench, it will be understood that other elongatebodies may be alternatively employed. For example, even a Q-tip, anappropriately dimensioned hollow straw, or solid rod may be inserted toachieve a similar result. Where a wrench 238 or other solid elongatemember is employed, it may be important that the cured or set dentalmaterial 236 not adhere strongly to wrench 238 to allow its removal. Thewrench or other elongate body 238 may be shaped to include a Morse taperto allow for secure seating and removal of the wrench or other elongatebody 238. Where a hollow straw is employed, removal of the straw may notbe required. Once the wrench or other elongate body 238 has beenremoved, one may employ a dental bur or similar tool to widen centralaccess channel 138, if desired. In another embodiment, one may place aremovable collar about elongate body 238 prior to filling well 204,which collar can be removed with elongate body 238 after curing orsetting, similarly resulting in a wider central channel 138.

In one embodiment, the elongate body inserted into well 204 may comprisea temporary abutment 238′ purchased from a dental product manufacturer(e.g., the same manufacturer who provided the implant or implantanalog). Such a temporary abutment may be configured similar to body 132shown in FIGS. 2A-2E. Such an embodiment is shown in FIG. 9B. Theabutment 238′ may already include any needed locking structure (e.g.,hex head 150) corresponding to recess 225. Thus, in such a case, theintroduced curable or otherwise settable dental material 236 need notenter into recess 225 (which recess may conveniently be entirely blockedby corresponding locking structure already disposed on temporaryabutment 238′, and seated within recess 225 implant or implant analog212).

In other words, temporary abutment 238′ may be used as a core aroundwhich the anatomical healing cuff body 144 a is cast within well 204.The abutment 238′ may be coupled to implant 212 by screw 140. In anotherembodiment, no screw may be employed. Where screw 140 is present, thescrew may be removed through channel 138. Thus, in this embodiment,screw 140 may not become bonded and integral with cured or set dentalmaterial 236 of the anatomical healing cap. Use of a temporary abutmentmay be particularly suitable when producing anatomical healing capshaving relatively large, wide healing cuff bodies (e.g., bicuspids ormolars). For smaller teeth, one may find the temporary abutment toolarge to be readily insertable into well 204 while allowing introductionof curable or otherwise settable dental material 236 therearound.

Although FIGS. 9B-9D show temporary abutments with cylindrical bodies,many commercially available temporary abutments include a lateralextension extending beyond the cylindrical body. Temporary abutments ofany shape or size can be used in the present invention.

FIG. 9C shows another alternative similar to that shown in FIG. 9B, butin which temporary abutment 238′ is of a lower profile, so that it doesnot extend out the top of well 204. In order to preserve an accesschannel 138, wrench 238 is inserted therein, after which the curable orsettable dental material 236 is introduced into well 204. Similar to theembodiment shown in FIG. 9B, removal of screw 140 may be possiblefollowing fabrication of the anatomical healing cap.

Examples of such temporary abutments that may be used as a core aboutwhich an anatomical healing cuff body is formed are available fromvarious manufacturers, including Glidewell Laboratories, located inNewport Beach, Calif. Such temporary abutments employed as a core may beformed of any of various materials (e.g., including, but not limited toplastics, such as polyether ether ketone (PEEK), metal, ceramic (e.g.,alumina, zirconia), etc.). Such temporary abutments, or any of thestructures described herein may be formed by any suitable technique(e.g., casting, molding, machining, 3D printing, use of DME files with a5 axis lathe, etc.)

In some embodiments (e.g., as shown in FIG. 9A), a screw may engagethreaded portion 227 of implant or implant analog 212. An implant wrenchmay be inserted in conjunction with such a screw to preserve an accesschannel 138. Such a screw may be retained within the produced healingcap, providing a healing cap with a screw already incorporated therein.In one embodiment, the head of any such screw may extend through thelength of any locking member (e.g., 150) to reinforce this otherwiserelatively thin neck region of the produced healing cap. For example,one may simply back a typical coupling screw out a couple of turns oruse a screw that is sufficiently long so as to extend through the narrowneck associated with locking member 150, into body 144 a. Such anembodiment including a longer screw is shown in FIG. 11. An example ofsuch a screw 140′ may include an enlarged head 240, an undercut centralportion 242 of decreased diameter relative to the enlarged head, and adistal threaded end 244, in which the threaded end defines a diameterthat is intermediate the diameter of the enlarged head and the centralportion. Such screw configurations (or backing out of a standardcoupling screw, which is relatively shorter) reinforces the more fragileportion of healing cap 130 a to prevent a break from occurring adjacentlocking member 150.

Any suitable curable or otherwise settable dental material may beemployed. Examples of such composite materials include, but are notlimited to, glass ionomer cements, zinc polycarboxylate cements, andacrylic based curable compositions, for example, ACCESS CROWN, availablefrom Centrix, located in Shelton, Conn. In one embodiment, the curableor otherwise settable dental material may comprise a radiopaque filler,e.g., a zirconia filled dental composite material. In addition tozirconia fillers, fillers including compounds of lanthanum, strontium,barium, zinc (e.g., zinc oxide), or combinations thereof may also beprovided in order to provide radiopacity.

In one embodiment, radiographic and/or position markers may beincorporated into the anatomical healing cap 130 a. For example, suchmarkers could be inserted into a well of a casting jig, which marker maybecome incorporated into the resulting anatomical healing cuff body thatis cast. In another embodiment, such markers may be included within atemporary abutment employed as a core about which the anatomical healingcap is formed. The markers would thus become a part of the healing cap.Such markers may be used to determine orientation, position, or otherspatial information through a digital scanning or imaging process (e.g.,CT scan, ultrasound, etc.) of the patient. Such markers may comprise anyof the described radiopaque materials described above, or other suitableradiopaque materials (e.g., radiopaque metal alloys).

While it has been described that the casting jig may be employed tomanufacture anatomical healing caps, and such manufacture may beachieved chair-side, it will be readily understood that a practitionermay choose to manufacture any number of anatomical healing caps prior toneeding them, thus, “chair-side” is to be broadly construed, includingwhere one may manufacture the anatomical healing cap prior to requiringits use. For example, a practitioner may choose to manufacture a smallinventory of anatomical healing caps, which are kept and used as needed.That said, many curable or otherwise settable dental compositions cureor set up within about 3 minutes or less, such that true chair-sidemanufacture of a desired anatomical healing cap is certainly possible.

Another embodiment may not necessarily employ a socket at a distal endof the well configured to releasably receive therein a dental implant ordental implant analog. For example, for manufacture of a pontic 130 a′,no coupling to a dental implant is needed. Thus, one may simply cast adesired pontic having the shape of the anatomical cuff body, and thepontic may be positioned into the prepared void in the patient's jawbone (without the need for any anchoring implant). The pontic may ratherbe anchored to adjoining teeth on one or both sides of the pontic. Suchpontics would be similar to the described healing caps, but would notrequire any mechanism for coupling to a dental implant. In addition,because no coupling to an implant is required, no central access channel138 may be needed. Thus, the pontic may be solid, without any hollowaccess channel. Such an embodiment is shown in FIG. 12.

9B

Another embodiment similar to that shown in FIG. 9B is described inconjunction with FIG. 9D. For example, the entire casting jig 200 (e.g.,both upper and lower portions 216 and 218) may be formed of the samematerial, e.g., comprising a single integral piece of material. Such acasting jig 200 may be formed of an elastomeric material (e.g., siliconeor polyvinyl siloxane), or a single piece of plastic. The casting jigcould be molded around the implant analog 212 (e.g., by introducingsilicone resin into a container around the analog, and allowing thesilicone to set). Rather than including an implant housing 214 thatserves as a cage (see FIG. 9B) and the implant analog 212 being insertedfrom the bottom of the casting jig, the analog may be removed orinserted into the casting jig 200 from above, at the top of the castingjig (e.g., through well 204). A hole or opening 221 in bottom surface220 of casting jig 200, may be provided through which an implement maybe inserted to push implant analog 212 upwards, into well 204, where itmay be removed, as desired (e.g., when it is desired to remove a formedanatomical healing cap, the assembly of the healing cap and coupledanalog may be upwardly pressed out).

As described in conjunction with FIG. 9B, a commercially availabletemporary or interim abutment 238′ may be used as a core about which theanatomical healing cap is formed. Temporary abutment 238′ may beinserted from above into analog 212. The typically keyed recess 225 ofanalog 212 may have been removed (e.g., drilled out), making the analog212 generic to any given key. The screw 140 may be screwed down tightlyinto threaded portion 227 of analog 212, securing the two together.Bis-acrylic or any other suitable curable or otherwise settable materialmay be introduced into drilled out recess 225 at the head of analog 212,to form a keyed recess structure within analog recess 225 thatcorresponds to the structure (e.g., keyed protrusion structure) of thetemporary abutment 238′. In this way, a generic analog 212 may be usedwith any proprietary keyed structure provided with commerciallyavailable temporary abutments 238′. Analog 212 may include a transversethrough-hole 246 or similar transverse recess that fills with such asettable material, helping to retain the bis-acrylic within analogrecess 225 once the settable material sets or cures (See FIG. 9D). Theabove procedures may be carried out with the analog and temporaryabutment 238′ located outside of the casting jig.

At this stage, the analog 212 and temporary abutment 238′ are placedwithin casting jig 200 if not already there, with analog 212 in socket210 of casting jig 200. Both may be introduced through the top ofcasting jig, via well 204. Where the casting jig is formed of anelastomeric material, the flexibility and elastic nature of the materialsurrounding socket 210 may allow easy insertion and withdrawal of analog212, as needed. With analog 212 in socket 210 and temporary abutment238′ screwed into analog 212, bis-acrylic or another suitable settabledental material 236 may be introduced into well 204 to form the desiredanatomical healing cap, including the buccal and lingual side handlelateral extensions 152, and 154′. Providing the T-shaped buccal sidehandle 152, and an oppositely disposed lingual handle extension 154′ isquite advantageous, as it provides two points disposed laterallyoutward, on the buccal and lingual sides for easy gripping andpositioning. Integrally formed handle portions 152 and 154′ may easilybe removed (e.g., cut away) once the healing cap is placed within thevoid 108, in implant 114. The presence of buccal and lingual handleextensions 152 and 154′ is further advantageous as they provide areadily visible indicator of the correct orientation of the healing capas it is seated within implant 114.

FIGS. 13A-13C illustrate an exemplary elongate handle that may be usedwith a casting jig system of the present invention. For example, acasting jig as described above (e.g., as shown in FIG. 5) may beprovided, including a body 202 including one or more wells 204 formedwithin the body. Each well may be open at a proximal end 206 and mayinclude a negative shape corresponding to an anatomical healing cuffbody of a given tooth position. Each respective anatomical healing cuffbody negative shape may include an asymmetrical cross-section and anirregular surface so that an anatomical healing cuff body having thatshape provides substantially custom filling of at least an emergenceportion of a void where a natural tooth once emerged from the void, orwhere a tooth would have emerged from the void.

A socket 210 may be provided at distal end 208 of each well, and anopening 221 in bottom surface 220 of the casting jig 200, which opening221 opens into the bottom of socket 210 (e.g., socket 210 may simply bethe top of the opening 221—where opening 221 extends from bottom surface220 to the bottom of well 204). As shown in FIGS. 13A-13C, the systemmay further comprise an elongate handle 250 that is insertable throughopening 221 in bottom surface 220 of casting jig 200. Of course, handle250 could also be inserted through the top surface of jig 200 (e.g.,through well 204). Elongate handle 250 may include a recessed connection225′ in a distal end 252 thereof, so that handle 250 may hold atemporary abutment used as a core 238′ (i.e., a temporary abutment core)within well 204 of casting jig 200 as an anatomical healing cuff body(e.g., 144 a) is formed about core 238′.

Handle 250 further includes a proximal grippable end 254 that may begrasped by the practitioner during use, as handle 250 is insertedthrough bottom opening 221. As seen in FIG. 13A, handle 250 may furtherinclude a generally vertical alignment marking 256 that may extend alonga length (e.g., at least a portion of the full length) of handle 250. Inan embodiment, vertical alignment marking is present at least at distalend 252, adjacent recessed connection 225′, as it is used to assessalignment of the abutment core 238′ that is retained within connection225′. For example, as seen in FIG. 16, generally vertical alignmentmarking 256 is aligned with a corresponding alignment marking (e.g., amark or flat, planar portion 241 on abutment core 238′), when core 238′is retained in distal end 252 of handle 250. These markings maycorrespond to the buccal side of the healing cuff body to be formed(i.e., T-shaped handle 152 seen in FIG. 18A may be on this side, alignedwith marking 256 and flat 241).

Handle 250 may further include a generally horizontal alignment marking258 extending along a width (e.g., around a perimeter) of the elongatehandle 250. Marking 258 may extend around the entire perimeter, or justa portion (e.g., a buccal front portion, as typically viewed by thepractitioner) thereof. Marking 256 (which also may extend the entirelength, or only a part of the handle) is disposed on the buccal frontportion. Marking 258 may advantageously be aligned with bottom surface220 of casting jig 200 during insertion into the casting jig, signifyingto the practitioner that elongate handle 250 is full seated withincasting jig 200. This is shown in FIG. 17A. For example, when so flushlyaligned, such alignment may signify that the abutment 238′ retainedwithin recessed connection 225′ is properly aligned vertically withinwell 204 of casting jig 200, so that when the curable or otherwisesettable material 236 is introduced into well 204 (e.g., between thesidewalls of the well defining the negative space and abutment 238′),the structures are properly positioned to produce the anatomical healingcuff body about core 238′. Thus, the practitioner may easily and quicklyverify that core 238′ is in the proper rotation relative to marking 256,and that core 238′ and handle 250 are inserted into jig 200 to theproper degree relative to marking 258.

As seen in FIG. 13A, distal end 252 of handle 250 may include aninternal threaded connection 227′ disposed proximal relative to recessedconnection 225′ so that a screw 140 advanced through hollow abutmentcore 238′ seated in recessed connection 225′ may be secured to handle250 by screw 140, as screw 140 is threaded into internal threadedconnection 227′. Thus, screw 140 may be used to secure core 238′ tohandle 250.

FIG. 13A illustrates distal end 252 including both a flared end (e.g.,so that distal end 252 is of a greater width or diameter than grippableproximal end 254), and a keyed structure within recess 225′. Forexample, such a keyed structure may be any suitable non-circularperimeter shape that requires a particular orientation of the abutmentcore 238′ being inserted into recess 225′. In the illustratedconfiguration of FIG. 13A, the keyed structure is a hexagonal recessinto which a correspondingly shaped and sized hexagonal locking member(e.g., 150) may be inserted. It will be appreciated that otherconfigurations similarly configured to lock against rotation will bereadily apparent to one of skill in the art (e.g., triangular, 4-sided,5-sided, use of non-circular curved sides, etc.), as described herein.

Flared end 252 of FIG. 13A provides sufficient length for internallythreaded portion 227′. Of course, such a threaded portion may also beprovided without a flared end, as seen in FIG. 13B.

FIG. 13B shows a similar configuration 250 a to that of FIG. 13A, butwhich does not include a flared end at distal end 252. This may allowthe vertical seating of the abutment 238′ coupled therein to be moreeasily adjusted, in the jig. FIG. 13C shows a configuration 250 b, alsosimilar to handle 250, but which includes a generic recessed connection225 b. As will be described in conjunction with FIG. 20, the genericrecessed connection 225 b of FIG. 13C may be employed with an abutmentcore of any desired manufacturer, allowing the practitioner to key thegeneric connection 225 b to whatever specific geometry the selectedabutment core may include.

FIGS. 14A-14B and 15A-15B illustrate an exemplary temporary abutmentcore 238′ about which the anatomical healing cuff body may be formed.Such an abutment core 238′ may be coupled into distal end 252 of handle250, within casting jig 200, to allow introduction of curable orotherwise settable dental material 236 into well, forming a cuff bodyhaving the desired anatomical shape provided by the negative shapedefined by the sidewall of well 204. In an embodiment, core 238′ mayinclude structure in the exterior surface to aid in retaining the cuffbody which is cast around core 238′. For example, the illustratedembodiment includes dimpled recesses 243, as well as perimeter grooves245. Although not shown, protruding structures could alternatively beprovided. In an embodiment, a structure providing an undercut (e.g., adovetail) may be provided, providing excellent mechanical retentionbetween the cast cuff body and core 238′ about which it is cast.

FIGS. 14C-14D and 15C-15D illustrate an alternative temporary abutmentcore 238″ as compared to that shown in FIGS. 14A-14B and 15A-15B. Suchan abutment core 238″ may also be coupled into distal end 252 of handle250, within casting jig 200 to allow introduction of curable orotherwise settable dental material 236 into a well. However, theabutment 238″ includes a plurality (e.g., three) of cutouts, 400 a-400c. A benefit of the cutouts 400 a-400 c is that when the practitionertakes a digital scan such as a CT scan, x-ray, or the like of theabutment 238″, the cutouts 400 a-400 c will improve the quality of thescan by reducing the amount of metal in the abutment, which metalmaterial can cause “scatter” in the image. Of course, in someembodiments, the core may be formed of a material other than metal.

It will be readily apparent to one of skill in the art that prior tointroduction of flowable dental material 236 into well 204, an abutmentcore cap having a shape that corresponds to the shape of the cutouts 400a-400 c of the abutment core 238″ may be inserted into the abutment core238″, which prevents flowable dental material 236 from filling thecutouts 400 a-400 c. After the flowable dental material 236 has cured orset, any such employed abutment core cap may be removed. The abutmentcore cap may be formed from a material that does not adhere to theflowable dental material 236 to allow its removal. Alternatively, eachprotrusion of the abutment core cap configured to correspond to one ofthe cutouts 400 a-400 c may be shaped using a shallow taper (e.g., about1-5°, such as a Morse taper) to allow for secure seating and removal ofthe abutment core cap. The cutouts 400 a-400 c may reduce the cure orset time of the flowable dental material 236 by providing an area forlight to access a larger portion of the anatomical healing cap 130 a.

In an embodiment, the cutouts 400 a-400 c may fill with flowable dentalmaterial 236 and thereby lock or otherwise secure the abutment core 238″to the anatomical healing cap 130 a. Such cutouts may also berecognizable in detail on a CT or similar scan, such that in anembodiment, such geometric cutouts may serve as markers. For example, inan embodiment including “radiopaque” or other markers on any of thecomponents described herein, such markers may simply comprise suchgeometric cutouts, whether they are actually formed of a material havinggreater radiopacity than the surrounding structures, or not. So long assuch cutouts or other geometric structures can be imaged in detail bythe CT or other scanning mechanism, they may serve as such markers.

Further, it will be readily apparent to one of skill in the art that theabutment 238″ is not limited to the configuration shown in FIGS. 14C-14Dand 15C-15D. For example, abutment 238″ is shown having three cutouts400 a-400 c, but the abutment 238″ may have as little as a singlecutout, or may have more than three cutouts. Similarly, the cutouts mayhave various depths, and be placed evenly or unevenly around theabutment 238″. Further, abutment 238″ may have cutouts that are evenlysized or unevenly sized.

The temporary abutment cores 238′ and 238″ may otherwise be similar toany temporary abutment commercially available from various manufacturers(e.g., Glidewell Laboratories, located in Newport Beach, Calif.). Anysuch temporary abutments, available from any of the variousmanufacturers may be employed as a core about which the anatomicalhealing cuff body is to be formed.

Elongate handle 250 may be of any desired length. In an embodiment, aswill be apparent from FIGS. 16-17B, handle 250 may advantageously belonger than the height or “thickness” of the associated casting jig itis employed with. For example, where casting jig may be about 1 to 2inches thick, handle 250 may be longer than the jig, e.g., more than 2inches, e.g., about 2.5 to about 3.5 inches in length. Of course, anysuitable length may be employed (e.g., which is longer than thethickness of the associated jig).

FIGS. 16-19 illustrate an exemplary method by which the presentlydescribed casting jig systems including elongate handle 250 may beemployed in manufacture of the desired anatomical healing cap (e.g., 130a). FIG. 16 illustrates how abutment core 238′ may be coupled into andretained within recess 225′ of handle 250 (a similar assembly ispossible with abutment core 238″). For example, locking member 150 ofabutment core 238′ may be inserted into recess 225′, and screw 140advanced, so as to secure core 238′ to distal end 252 of handle 250.While FIG. 16 illustrates such coupling outside of casting jig 200, itwill be appreciated that this may be accomplished within the casting jigby inserting handle 250 through the opening 221 in the bottom 220 of thecasting jig 200, from below, while also inserting core 238′ into well204, from above. Once core 238′ meets handle 250 (e.g., locking member150 slides into corresponding recess 225′), screw 140 may be tightened,as shown in FIG. 17A. In some embodiments, it may be easier to insertcore 238′ from above and handle 250 from below casting jig 200, e.g.,where flared portion 239 of core 238′ would otherwise make it difficultor impossible to introduce core 238′ into well 204 from opening 221 andsocket 210. As such, handle 250 may be inserted into socket 210 frombelow, while core 238′ may be inserted into well 204 from above. Ofcourse, both core 238′ and handle 250 may also be inserted from the topof jig 200 (e.g., through well 204). This may be accomplished with core238′ coupled into recess 225′. Like the core 238′, the abutment core238″ can also be positioned into the well 204 from below or above.

It will be apparent from FIGS. 17A and 17B that handle 250 takes theplace of any implant or implant analog, as handle 250 includes therecessed connection 225′ in its distal end 252, effectively becoming theimplant analog. Thus, in such embodiments, no other dental implantanalog (e.g., analog 212) may be needed. FIG. 17B illustrates how oncecore 238′ has been properly seated into recess 225′ (e.g., using screw140) the curable or otherwise settable dental casting material 236 maybe introduced into well 204, between the sidewall of well 204 and wall132 of core 238′ (a similar process is possible with abutment core238″). Before so doing, the practitioner may verify that an alignmentmarking (e.g., flat portion 241) of core 238′ is aligned with generallyvertical alignment marking 256, and the bottom 220 of casting jig 200 isaligned with generally horizontal alignment marking 258. While flatportion 241 is shown as an example of a marking on core 238′ thatcorresponds to line 256, it will be apparent that any suitable structureor mark may be employed, so long as the practitioner may recognize thatthe two structures or marks are aligned axially with one another. Forexample, if using abutment core 238″, the vertical alignment marking 256may be aligned with a flat provided thereon, or one of cutouts 400 a-400c. As such, the term “alignment marking” is to be broadly construed toinclude any such marks or structures.

In an embodiment, the markings 256 and 258 may include a scribed line,groove or raised ridge. They may include a colored portion therein orthereon, so as to provide contrast relative to the adjacent portions ofhandle 250 (e.g., red or black on a white or lightly colored handle, orwhite or red on a black or darkly colored handle, etc.). Such coloredmarkings may be printed, painted, or otherwise applied. The markingcould similarly comprise a flat elongate or planar portion 241 in anotherwise curved surface, as shown with flat 241 with respect to core238′. Core 238′ could similarly comprise a colored or shaped marking(e.g., a protrusion, groove, recess, etc.), other than the illustratedflat portion 241 (e.g., a printed or painted dot, line, or other mark ofa color contrasting with the background). In the abutment core 238″, thecutouts 400 a-400 c can be used to verify that the core 238″ is properlyaligned within the casting jig 200. Any of the described markingsemployed on the handle may alternately be employed on cores 238′ and238″, and vice versa.

Because of the alignment between markings 256 and 241 or marking 256 andone of the cutouts 400, the practitioner is assured that core 238′ or238″, respectively, is rotated properly within recess 225′. Because ofthe alignment between marking 258 and bottom surface 220, thepractitioner is assured that core 238′ or 238″ is advanced into well 204to the proper degree. Markings 256 and 241 or marking 256 and one of thecutouts 400 may correspond to the buccal side of the finished anatomicalhealing cap 130 a (e.g., the T-shaped handle 152 may also be disposed onthe buccal side, as seen in FIG. 18A with the core 238′).

In some circumstances, the practitioner may wish to counter-rotate thehandle 250 relative to core 238′ or 238″, e.g., to compensate for adental implant that is misaligned, to accommodate crowding of adjacentteeth, etc. This may be easily achieved by deliberately mis-aligning themarking 256 relative to the marking 241 or the marking 256 relative toone of the cutouts 400, in order to make such a compensation formis-alignment within the patient's anatomy or the implant.

The practitioner may maintain handle 250 and core 238′ or 238″ withincasting jig 200 until material 236 has hardened to the desired degree(e.g., about 3 minutes or less). Once material 236 has hardened, screw140 may be accessed through channel 138. Loosening screw 140 allows theformed anatomical healing cap 130 a to be removed from the casting jig200. For example, anatomical healing cap 130 a may be removed throughthe top, through well 104, while handle 250 may be removed through thebottom opening 221. FIG. 18B illustrates a cross-sectional view of thehandle 250 and formed anatomical healing cap 130 a using core 238′.

FIG. 19A illustrates the anatomical healing cap 130 a using core 238′,and FIG. 19B illustrates the anatomical healing cap 130 a using core238″.

FIG. 20 shows how a generic recessed connection 225 b (e.g., such asthat of FIG. 13C) may be employed with an abutment core of any desiredmanufacturer, allowing the practitioner to key the generic connection225 b to whatever specific geometry the selected abutment core 238′ mayinclude. This may be achieved in a similar manner as described aboverelative to FIG. 9D. For example, a core 238′ including a keyed lockingmember (e.g., hexagonal member 150) may be inserted into circular recess225 b, and a curable or otherwise settable composition 247 (e.g., thesame as used in forming cuff body 144 a) may be injected into the spacebetween circular sidewall of recess 225 b and locking member 150. Thiseffectively converts the distal end of handle 250 b so as to bespecifically keyed to the temporary abutment inserted therein, used as acore about which the cuff body is later formed. The sidewall definingrecess 225 b may include a recess or through-hole 246′ or similartransverse (e.g., radially or sideways extending) recess that fills withsuch a settable material, helping to retain the injected material 247within analog recess 225 b once the injected settable material sets orcures.

FIGS. 21A-23 illustrate a crown forming jig that may be used to formchair-side manufactured temporary crowns from, e.g., a bis-acrylicmaterial or other suitable temporary crown forming material for use wheninstalling the above described anatomical healing caps. FIGS. 22C and 23show the finished crown 320. Crown forming casting jig 300 includes abody 302 including one or more wells 304 disposed within body 302. Eachwell 304 may be open at a proximal end 306, and include a negative shapecorresponding to the exterior surface and contour of a crown portion ofa given tooth position. In other words, just as the casting jig 200described above includes a negative shape that when filled with asettable dental material provides a healing cuff having the anatomicalshape needed to provide substantially custom filling of the void, thiscasting jig 300 includes a negative shape that when filled with asettable dental material (e.g., bis-acrylic), it provides a crown thathas the shape and contours of the exterior surfaces of the crown portionof a natural tooth.

The casting jig further includes a first portion 308 a of an alignmentmechanism. Portion 308 a may be disposed on or in the proximal topsurface 306 of body 302 of crown forming casting jig 300. For example,in the illustrated embodiment, first portion 308 a of the alignmentmechanism may comprise one or more recesses arranged about well 304,which recesses may accept and mate with a corresponding second portion308 b of the alignment mechanism (e.g., configured as a matingprotrusion).

The second portion 308 b may comprise a portion of a slug 310 (e.g., apolycarboxylate slug) that is pressed into the uncured bis-acrylicduring use, displacing a portion of the bis-acrylic material so that thebis-acrylic material in well 304 assumes the shape of a hollow crown.The slug 310 includes a central downwardly protruding displacement body312, which is axially aligned over well 304, and pressed into well 304,displacing the bis-acrylic material outwardly, towards the sidewalldefining well 304, so that as the bis-acrylic hardens, it includes ahollow central portion or core where the displacement body 312 is.

Slug 310 includes second portions 308 b of the alignment mechanism,which second portions may comprise protrusions at the ends of extensionarms 314 extending laterally outward (i.e., sideways) from the centraldisplacement body 312 of slug 310. As slug 310 is pressed downwardlytowards casting jig body 302, displacement body 312 is introduced intowell 304, displacing the bis-acrylic material from the center, towardsthe outside wall of well 304. Slug 310 may include a generally vertical,upwardly oriented handle 311 to facilitate its insertion and removal.The practitioner is able to visually align protrusions 308 b withcorresponding recesses 308 a of body 302, which aids in guidingdisplacement body 312 into well 304 under proper alignment. Downwardadvancement of slug 310 relative to body 302 may proceed untilprotrusions 308 b contact the bottom surface of corresponding recesses308 a (i.e., they act as a stop). At this position, slug 310 is fullyinserted, as seen in FIG. 22B.

This position may be configured so as to ensure that the exteriorsurface 316 of displacement body 312 is a given distance from theadjacent interior surface 318 of well 304, defining a casting cavitytherebetween of desired thickness. In an embodiment, the casting cavitymay have a substantially uniform thickness, e.g., providing about 0.5 mmall around body 312 and sidewall 318. Such a thickness provides thefinished hollow crown 320 formed from the bis-acrylic with asubstantially uniform thickness corresponding to that provided by thecavity, e.g., about 0.5 mm. For example, the casting cavity and crownthickness may be from about 0.1 mm to about 2 mm, from about 0.25 mm toabout 1 mm, or from about 0.3 mm to about 0.75 mm.

As seen in FIGS. 21A-21B, the well 304 of crown forming jig 300 mayinclude a portion of the void of the well that forms a handle 321 (e.g.,a T-shaped handle) that extends from the buccal side of the resultingfinished crown 320, as seen in FIG. 23. Such a T-shaped handle may besimilar to handle 152 (e.g., including a shaft and cross-bar similar toshaft 154 and cross bar 156 as seen in FIG. 2H). As shown, such a handle321 may extend laterally (i.e., sideways) from the buccal side of crown320, making it more easily graspable by the practitioner as thepractitioner positions and holds the crown in the desired position(e.g., as it is bonded to the anatomical healing cap).

Displacement body 312 of slug 310 may provide an exterior surface 316that is also in the shape of the crown, i.e., the negative shapeprovided by the sidewall 318 of well 304. Thus, when fully inserted,exterior 316 of body 312 and sidewall 318 may be substantiallyconcentric with one another, with exterior 316 following the contour ofsidewall 318, so as to provide the finished crown 320 with asubstantially uniform thickness. For example, the shape of body 312 maybe that of a polycarboxylate crown former. In another embodiment, thethickness may not be uniform. For example, body 312 could simply be acylinder, pyramid or other shape that is inserted into well 304,although substantially uniform thickness and the corresponding shape ofbody 312 may be preferred.

The method and crown forming casting jig may be particularlyadvantageous where the curable or otherwise settable casting materialdoes not adhere to the sidewall 318 of well 304, or to displacement body312 during manufacture. This allows the finished crown to be easilyretrieved from jig 300 and slug 310. In an example, the curable orotherwise settable casting material comprises an initially uncuredbis-acrylic dental material, and the displacement body comprisespolycarboxylate. Such materials are relatively inexpensive, and will notadhere to one another as the bis-acrylic cures, but are advantageouslyeasily separable. The crown casting jig 300 may be formed of anelastomeric material (e.g., silicone, a polyether, etc.). Any of thematerials described above relative to casting jig 200 may be employed(e.g., whether rigid, flexible, or elastomeric). It will be appreciatedthat other materials that are similarly non-adhesive to one another mayalso be used for displacement body 312 and injectable material 319,other than polycarboxylate and bis-acrylic, respectively.

Once the finished crown 320 has hardened (e.g., about 1 minute), it maybe luted or otherwise bonded to an appropriate anatomical healing cap(e.g., as much of the proximal exposed portion top end of the anatomicalhealing cap may be removed as desired). For example, the preparedanatomical healing cap positioned within the void and anchored to thedental implant may have the crown placed thereover, a luting cement orother suitable bonding material may be disposed therebetween, thepatient may be instructed to gently bite down on the crown seated on theanatomical healing cap, and the bonding material (e.g., a light curableadhesive) may be exposed to a dental curing light, securing thetemporary crown in place. As shown in FIG. 23, the practitioner may wishto cut off any burrs, flashing, or perform any quick preparation orshaping of the crown after hardening with a dental bur 180 or othertool, before placement over the anatomical healing cap.

Such a procedure allows a practitioner to easily and quickly manufacturea temporary crown from an inexpensive bis-acrylic material, and quicklysecure the crown over the installed anatomical healing cap. If desired,a VITA-SHADE colored resin or other material may be injected into thehollow crown 320 before placement over the anatomical healing cap (e.g.,130 a) to provide a more aesthetically accurate crown, with some degreeof tooth coloring (e.g., as teeth are not stark white—but include shadesof yellow, red, brown, gray, etc.).

Although principally described and illustrated in a configuration wherethe insertion of the displacement body 312 into well 304 results in ahollow crown 320, it will be appreciated that a slug with anyconfiguration may alternatively be inserted into well 304 (or none atall), which may result in a solid, rather than a hollow temporary crown.Such a crown may be demolded from well 304, and luted or similarlybonded to the anatomical healing cap in-situ (e.g., by placing thetemporary crown over the healing cap and having the patient bite downthereon, and exposing a light cure adhesive between the crown and cap toa dental curing light. Such solid crowns may be inexpensively and easilyformed using bis-acrylic or a similar temporary crown materialintroduced in a flowable condition into the well 304, after which it isallowed to cure or otherwise set. Such a solid crown may be aided inremoval from the well by inserting an appropriately dimensioned hollowstraw, or solid rod (e.g., similar to a toothpick) into the materialbefore or as it cures to aid in its removal from the well. Such may becut or otherwise removed before placement in the patient's mouth.

The provisional crown 320 may be removed (e.g., by loosening the screwcoupling the anatomical healing cap into the dental implant) at a laterstage (e.g., weeks later) when a permanent crown (or other restoration)has been prepared and is ready for installation. Of course, it couldalso be removed by breaking or cutting it off. In any case, at thispoint, because the anatomical healing cap has been in the void of thealveolar ridge for this period of time (e.g., several weeks), thegingival tissue surrounding the void has not collapsed into the void,but has been supported by the anatomical healing cap for the entirehealing time. It will be apparent that temporary restorations other thancrowns (e.g., bridges, inlays) may be formed using an appropriatelyconfigured crown forming casting jig where the well of the casting jigincludes a negative shape corresponding to the desired bridge, inlay,etc.

As used herein, the terms “proximal” and “distal” may generally refer tothe orientation or position of the given structure relative to the endof the device being manipulated. Thus, the end 254 of handle 250 may be“proximal”, while locking member 150 of core 238′ or 238″ may be“distal”, even though the distal end of core 238′ may be coupled intothe distal end of handle 250. This is because when the anatomicalhealing cap that may include core 238′ or 238″ is installed into apatient's mouth, the end including locking member 250 is “distal” as itis being installed.

IV. Methods for Taking a Scan or Impression

As mentioned herein, a practitioner may wish to take an impression, ormake a scan (e.g., a digital or other scan such as a CT scan, x-ray, orthe like) of the structures and surfaces surrounding the anatomicalhealing cap once it has been placed into the subgingival void 108. Underexisting methods, the practitioner typically removes the cap or cuff 116(seen in FIG. 1F), and couples an impression post or scanning body intothe implant. With the impression post or scanning body in place, theimpression or digital scan is taken. The impression post or scanningbody may then be removed, and the cap or cuff 116 replaced. It will beapparent that such methods are undesirable, as they require removal ofthe cap or cuff, followed by its eventual replacement.

The present disclosure provides alternative methods by which apractitioner can take a scan and/or impression of the structures andsurfaces surrounding the anatomical healing cap and/or temporary crown.One alternative method allows the impression post or scanning body(depending on whether an impression or a scan is being taken) to beseated directly into the anatomical healing caps described herein,resulting in a stack of three structures (the implant 114, theanatomical healing cap 430, with the impression post or scanning body462 on top). For example, the anatomical healing cap itself may makeprovision for receipt of the impression post or scanning body therein.Mechanisms for keying the interior of the hollow anatomical healing capwith the scanning body (or impression post) may be provided. Of course,a provisional crown or the like may also be provided on top of theanatomical healing cap.

FIGS. 24A-24B show how a scanning body or impression post 462 a may beinserted into an open end 137 associated with the hollow channel 138 ofa healing cap 430 a formed around the temporary abutment 238′(. FIGS.24C-24D show how a scanning body or impression post 462 b may beinserted into the open end 137 associated with the hollow channel 138 ofa healing cap 430 b formed around the temporary abutment 238″. The termsscanning body and impression post may be used interchangeably herein(e.g., where one may be selected if a scan is to be made, the other tobe selected if an impression is to be taken). The two structures maygenerally be similar to one another in shape, size, etc. Typically, animpression post may be formed of metal, while a scanning body maytypically be plastic. Such structures are typically too weak to serve asa permanent post supporting a crown or the like.

As shown in FIGS. 24A-24D, scanning bodies or impression posts 462 a and462 b and anatomical healing caps 430 a and 430 b may be keyed to oneanother, to ensure desired rotative orientation of bodies or posts 462 aand 462 b within anatomical healing caps 430 a and 430 b.

FIGS. 25A-25B show perspective and cross-sectional views of ananatomical healing cap 430 a formed around temporary abutment 238′. Itwill be appreciated that any of the anatomical healing caps describedherein may be provided with keyed or other features described inconjunction with the anatomical healing caps 430 a. For example, one ormore grooves 464 a may be provided within channel 138, where the grooves464 a extend from the open end 137, vertically downward some givenlength. A plurality of such grooves may be provided, of differentlengths relative to one another. Scanning body or impression post 462 amay include one or more mating protrusions 464 b which are configured tomate within grooves 464 a.

FIGS. 26A-26B show perspective and cross-sectional views of theimpression post or the scanning body 462 a used in FIGS. 25A-25B.Different length grooves 464 a may ensure proper orientation of scanningbody or impression post 462 a in channel 138 of anatomical healing cap430, as if the scanning body 462 a is mis-rotated, it will either notslid down into channel 138, or it will not slide down so that eachprotrusion 464 b seats within the bottom of each respective groove 464a. For example, if the grooves 464 a and protrusions 464 b are alignedwith one another, but mis-matched (not of the same length), then thescanning body or impression post 462 a will slide down into channel 138only until the bottom of the shortest groove is reached.

At such position, it will be apparent that the scanning body orimpression post 462 a sits too high in channel 138, and the practitionerwill realize that further rotation within channel 138 is needed, suchthat body or post 462 a may be withdrawn, rotated, and reinserted. Thegrooves (and protrusions) may be of differing widths if it is desired toensure that insertion may only occur at the correct rotated orientation.Such grooves (and protrusions) may be equally spaced around theperimeter of body or post 462 a and the interior surface of channel 138,or otherwise arranged, as desired (e.g., three protrusions/grooves 120°apart, or four protrusions/grooves 90° apart). Color coding, numbering,or other matching indicia may be used to aid the practitioner inachieving correct rotational alignment of the protrusion(s) andgroove(s)

FIGS. 25C-25D show perspective and cross-sectional views of ananatomical healing cap 430 b formed around temporary abutment 238″. Thecutouts 400 a-400 c of the abutment 238″ are both wider and deeper thanthe grooves 464 a. Therefore, as shown in FIGS. 26C-26D, which showperspective and cross-sectional views of the impression post or thescanning body 462 b used in FIGS. 25C-25D, the one or more protrusions464 b of the scanning body 462 b are correspondingly wider and deeper toform a stable interface. Like the grooves 464 a (and protrusions 464 b),the cutouts may aid in the correct insertion of the impression post orscanning body 462 b.

With the body or post 462 fully seated in channel 138, the practitionermay then proceed to take an impression or scan, as is the preference ofthe practitioner. In order to provide a further check to thepractitioner that seating of the body or post 462 in channel 138 iscomplete, a marking (e.g., dot, groove, protrusion, horizontal line, orthe like) may be provided, e.g., on the exterior of the body 462, e.g.,which may align vertically with the top 137 or channel 138. Seeing ahorizontal line or other marking aligned with top 137 may serve toinform the practitioner that full seating has occurred, much likehorizontal line 258 informs the practitioner of correct seating in thecasting jig as described in conjunction with FIGS. 13A-17B, above.

It is not necessary that the body or post 462 be coupled by screw orsimilar mechanism into the anatomical healing cap 430, although suchcould be provided for, if desired. The screw or similar mechanism couldterminate within the anatomical healing cap 430 or extend through theanatomical healing cap 430 into the implant (e.g., implant 114). In apreferred embodiment, no such screw is provided, such that theanatomical healing cap may be screw coupled into the implant (e.g.,implant 114), but where no screw coupling is provided between anatomicalhealing cap 430 and body or post 462. In some embodiments, body or post462 may be provided with a mechanism that allows the received portion ofthe body or post 462 to exert an outward pressure onto channel 138,aiding to hold it in place while being used. Such mechanism may beselective, e.g., allowing the practitioner to lock the body or post 462in place, and then to release such mechanism when the impression or scanhas been completed, and body or post 462 is to be removed. Such amechanism could provide a mechanical switch, trigger, or button (e.g.,at the top of post 462) which upon actuation may cause a perimeterportion of body or post 462 to extend laterally or radially outward,exerting increased pressure against the interior of channel 138. Releaseof such mechanism may cause retraction to the initial (e.g., default)position, making it easier for the practitioner to then pull body orpost 462 from channel 138. At least one of the one or more protrusions464 b of the body or post 462 could also be shaped using a shallowtaper, such as a Morse taper, which may allow the body or post 462 toseat more firmly within the anatomical healing cap 430.

Where a scan is being taken rather than an impression, the practitionermay find it helpful for the anatomical healing cap 430, the scanningbody 462, or both to include radiopaque markers incorporated therein,providing a reference about which the image derived from the scan can becreated. For example, the protrusions 464 b may comprise a radiopaquematerial, and/or grooves 464 a may be coated with a radiopaque material.Where such protrusions, cutouts, or grooves are of different lengths,the difference in lengths may aid in compiling (e.g., aligning) theimages from the scan data, as the different length protrusions and/orgrooves are unique to one another, each creating a reference point forthe scanner image alignment.

In addition, while alignment structures employing vertical grooves orother structures may be described in some detail, it will be appreciatedthat other alignment mechanisms can be used, within the scope of thepresent invention. Non-limiting examples include internal indentationson the inside of the hollow core that the scanning body engages, withcorresponding détentes or protrusions (keyed to one another), or screwthreads on the (e.g., inside or outside) wall of the hollow core thatwould allow the scanning body (including corresponding mating threads)to screw into, providing complementary structures that are keyed to oneanother. Numerous other alignment structures may be apparent to those ofskill in the art, in light of the present disclosure.

Before conducting such a scan, the practitioner may apply a radiopaquepowder (e.g., any of the radiopaque materials identified herein, inpowdered form), a radiopaque liquid, or other spreadable radiopaquematerial (e.g., flowable) around the gingival cuff and any othersurrounding surfaces, so that these surface contours better show up inthe scan.

It will be appreciated that such embodiments simplify the overallprocess required by the practitioner, by allowing taking of animpression, or taking a scan without actually having to remove thehealing cap 430, but by providing the ability to seat the scanning bodyor impression post 462 into the healing cap 430 itself. This allows thepractitioner to take the desired impression or scan while leaving thehealing cap 430 in-situ, in place in the subgingival void.

An alternative method provides the practitioner with an accurate scan ofthe structures and surfaces surrounding the anatomical healing cap 430and/or temporary crown without necessarily using a scanning body orimpression post 462 in the patient's mouth. For example, after a healingcap 430 and/or temporary crown is provided, and optionally customized tothe individual patient (e.g., by sculpting, as desired), but before thehealing cap 430 and/or temporary crown is seated within the patient'smouth, the practitioner may take a scan of the healing cap 430 and/ortemporary crown. The practitioner may choose to use a scanning body orimpression post 462 when scanning the healing cap 430 and/or temporarycrown, and this may be performed outside the patient's mouth. This givesthe practitioner an excellent reference scan of the healing cap thatwill be installed in the patient's oral cavity, including those portionsof the healing cap that will be located sub-gingivally, afterinstallation.

Once the healing cap 430 and/or temporary crown is installed and seated(e.g., in the implant), the practitioner may take a second scan (e.g.,an intraoral surface scan) of the installed healing cap and the areasurrounding the healing cap 430 and/or temporary crown. The area may bescanned after the bone and gum tissue surrounding the healing cap 430and/or temporary crown has at least partially healed (e.g., about 4months after the first scan).

The use of a scanning body or impression post 462 may not be necessarybecause a sufficient number of reference markers may be present on thehealing cap 430 and/or temporary crown themselves, which allows thepractitioner to create a composite of the two scans, by preciselyaligning the healing cap 430 and/or temporary crown (e.g., the exposedportions that are not sub-gingival) seen in the second scan with thosesame reference markers (e.g., structural features of the healing capand/or crown) from the first scan. This allows the practitioner tocreate an overall scan of the patient's oral cavity, with the temporaryabutment, any crown, the implant, and surrounding surface tissues andother surface features present, all precisely placed in the scan. Such ascan also allows the practitioner to form a permanent crown or otherpermanent prosthesis from the scan, because of the accuracy and highprecision provided by the composite scanned image data, from the twoscans taken at different times (before and after healing of the tissuesurrounding the void). The overall composite scan may be used by thepractitioner to design and/or seat the permanent crown or otherprosthesis.

Because the subgingival portion of the healing cap 430 and/or temporarycrown may not be captured by an intraoral surface scan (rather thanimaging that penetrates and images subsurface tissues and structures),it can be important to have captured the subsurface features of thehealing cap, etc. in the first scan, so that they can be shown (andused) in the overall composite scanned image. A practitioner may use ascanning body to scan the subgingival portion of the healing cap 430and/or temporary crown that is configured for coupling to a dentalimplant 212. Such a scan may allow the practitioner to capture theinterior geometry of the dental implant 212, as well as normally hiddensurfaces of the subgingival portion of the healing cap 430 and/ortemporary crown in an extraoral scan.

For example, FIG. 27 shows an alternative scanning body 462 c than thoseshown in FIGS. 25A-26D, wherein the scanning body or an analog isconfigured to mate with the locking member 150 of the healing cap,analogous to the dental implant 212. The scanning body 462 c may beconfigured to receive screw 140, e.g., to secure a scanning body to thehealing cap. In an embodiment, when scanning the healing cap 430 and/ortemporary crown outside the patient's mouth before seating, thepractitioner may use two scanning bodies, e.g., 462 c in combinationwith one of 462 a or 462 b. The scans produced from a scanning body 462a-462 c may be used as extraoral references in the method describedabove for producing a composite scan of the patient's oral cavity.

An embodiment of the present invention is directed to method of taking ascan of a patient's oral cavity by providing a healing cap configured tobe received within a subgingival void of a given tooth position, takinga first scan of the healing cap, wherein the first scan is taken outsideof a patient's oral cavity, seating the healing cap into the subgingivalvoid of the given tooth position, the seating including coupling thehealing cap into an implant disposed adjacent the healing cap, in thesubgingival void, and taking a second scan, which is an intraoral scanof the healing cap and surrounding surfaces once the healing cap isseated, taken inside the patient's oral cavity. The first scan of thehealing cap can then be integrated with the intraoral second scan of thehealing cap and the surrounding surfaces into an overall oral cavityscan. A third scan, (e.g., a 3D cone beam scan), can be taken, which isoverlaid or otherwise integrated with the first and second scans, foruse in fabrication of a dental prosthesis. In addition, the scans can beintegrated with 3D CAD model data (e.g., DME file data) for the implantinto which the healing cap is being seated, to facilitate correctorientation of the implant relative to the dental prosthesis beingfabricated.

The three scanning concepts outlined above can be further mixed andmatched, to provide various other possibilities of prosthesisfabrication, whether one uses the anatomical healing abutments and/orother technology of Applicant as described in the present application,or uses other structures that are not proprietary to Applicant (e.g.,other manufacturer's healing abutments, etc.).

For example, such may include using a scan body by placement into theabutment from the occlusal surface with use of any desired scanningtechnology.

Another example may include extra-oral scanning of an apical scannableanalog that is coupled with the healing cap (e.g., whether the healingcap is Applicant's anatomical healing cap, or any other healing cap(e.g., even a non-anatomical, circular cross-section healing cap). Theresulting scan is overlayed (e.g., integrated) with an intraoral digitalscan taken with the healing cap coupled into the implant, for use infabricating a desired prosthesis.

Another example may include taking a CT or other scan of the implantcoupled with a round (e.g., circular) or anatomical healing cap (e.g.,with Applicant's proprietary abutment in the core), where such is usedto fabricate a desired prosthesis.

Another example may include taking a CT or other scan of the implantcoupled with a round (e.g., circular) or anatomical healing cap (e.g.,with Applicant's proprietary abutment in the core), and in the same CTor other scan, capturing Applicant's proprietary implant which willallow for double verification of implant and abutment orientation, wheresuch scan(s) can be used to fabricate a prosthesis.

Another example may include taking a CT or other scan, e.g., withApplicant's proprietary implant coupled with a healing abutment (e.g.,circular or anatomical) or coupled with a provisional anatomic crown orabutment (e.g., from Applicant or another manufacturer), where suchscan(s) are used to fabricate a prosthesis.

Another example may include taking a CT or other scan of Applicant'sproprietary implant and fabrication of a provisional restoration orfinal prosthesis without an intraoral scan.

Another example may include taking a CT or other scan using Applicant'sproprietary implant coupled with Applicant's abutment with an anatomicalor circular healing cap for fabrication of a prosthesis.

In an embodiment, any of the image scans may be a 3D radiography (e.g.,3D x-ray) image scan, providing 3-dimensional image data from x-rayscan(s) (e.g., standard x-ray scan(s).

As used in this specification and the appended claims, the singularforms “a,” “an” and “the” include plural referents unless the contextclearly dictates otherwise.

The present invention can be embodied in other specific forms withoutdeparting from its spirit or essential characteristics. Thus, thedescribed implementations are to be considered in all respects only asillustrative and not restrictive. The scope of the invention is,therefore, indicated by the appended claims rather than by the foregoingdescription. All changes that come within the meaning and range ofequivalency of the claims are to be embraced within their scope.

1. A method of taking a scan of a patient's oral cavity for use infabricating a dental prosthesis, and actually fabricating the dentalprosthesis, the method comprising: providing a healing cap configured tobe received within a subgingival void of a given tooth position; takinga CT first scan of the healing cap coupled into an implant, wherein thefirst scan is taken outside of a patient's oral cavity; and fabricatinga provisional restoration or a final prosthesis from the CT first scan,where the method does not include taking any intraoral scan.
 2. A methodof taking a scan of a patient's oral cavity for use in fabricating adental prosthesis, the method comprising: providing a healing capconfigured to be received within a subgingival void of a given toothposition; taking a CT first scan of the healing cap coupled into animplant, wherein the first scan is taken outside of a patient's oralcavity; and fabricating a prosthesis from the CT first scan.
 3. Themethod as recited in claim 2, wherein the healing cap is an anatomicalhealing cap.
 4. The method as recited in claim 2, wherein the healingcap is non-anatomical, having a circular cross-section.
 5. The method asrecited in claim 1, wherein the method comprises taking a 3D radiographyscan, which provides 3-dimensional image data from one or more x-rayscan(s).
 6. The method as recited in claim 1, wherein the methodcomprises taking a 3D radiography scan, wherein the one or more x-rayscan(s) are standard x-ray scan(s).
 7. A method of taking a scan of apatient's oral cavity for use in fabricating a dental prosthesis, themethod comprising: providing a healing cap configured to be receivedwithin a subgingival void of a given tooth position; taking a first scanof the healing cap, wherein the first scan is taken outside of apatient's oral cavity; seating the healing cap into the subgingival voidof the given tooth position, the seating including coupling the healingcap into an implant disposed adjacent the healing cap, in thesubgingival void; taking a second scan, which is an intraoral scan ofthe healing cap and surrounding surfaces once the healing cap is seated,taken inside the patient's oral cavity; and integrating the first scanof the healing cap with the intraoral second scan of the healing cap andthe surrounding surfaces into an overall oral cavity scan; taking athird scan, which is a 3D cone beam scan or other image producing scantechnique, which third scan is overlaid or otherwise integrated with thefirst and second scans, for use in fabrication of a dental prosthesis;and integrating the scans with 3D CAD model data for the implant intowhich the healing cap is being seated, to facilitate correct orientationof the implant relative to the dental prosthesis being fabricated;wherein any of the first, second or third scans are taken with orwithout an apical or other scanning body coupled to the healing capand/or implant; wherein one or more of the image scans is a 3Dradiography image scan, providing 3-dimensional image data from standardx-ray scan(s).
 8. The method as recited in claim 7, wherein the 3D CADmodel data for the implant comprises a DME file.
 9. The method asrecited in claim 7, wherein the third scan is a 3D cone beam scan and isnot an intraoral scan.
 10. The method as recited in claim 7, wherein ascanning body is inserted into an occlusal surface of the healing cap,and wherein at least one of the first, second or third scans is taken ofthe scanning body and healing cap, with the scanning body received inthe healing cap.
 11. The method as recited in claim 7, wherein the firstscan is taken with an apical scannable analog coupled with the healingcap, where such first scan is integrated with the second scan, which istaken with the healing cap coupled with the implant, such scans beingused to fabricate the prosthesis.
 12. The method as recited in claim 11,wherein the healing cap is an anatomical healing cap.
 13. The method asrecited in claim 11, wherein the healing cap is non-anatomical, having acircular cross-section.
 14. The method as recited in claim 7, wherein atleast one of the first or second scan is a CT scan taken of the implantcoupled with the healing cap, wherein the healing cap is formed as atwo-part core and shell structure, where the core is an abutment, aroundwhich the shell of the healing cap is formed.
 15. The method as recitedin claim 14, wherein the healing cap is an anatomical healing cap. 16.The method as recited in claim 14, wherein the healing cap isnon-anatomical, having a circular cross-section.
 17. The method asrecited in claim 7, wherein at least one of the first or second scan isa CT scan taken of the implant coupled with the healing cap, wherein thehealing cap is formed as a two-part core and shell structure, where thecore is an abutment, around which the shell of the healing cap isformed, wherein the CT scan captures the implant, allowing doubleverification of implant and healing cap orientation relative to oneanother.
 18. The method as recited in claim 17, wherein the healing capis an anatomical healing cap.
 19. The method as recited in claim 17,wherein the healing cap is non-anatomical, having a circularcross-section.
 20. The method as recited in claim 7, wherein at leastone of the first or second scan is a CT scan taken of the implantcoupled with the healing cap, wherein the healing cap is in the form ofa provisional anatomical crown